• Christina Massoth, Mira Küllmar, Pajares MonchoAzucenaA, González-Suárez Susana, Evgeny Grigoryev, Artem Ivkin, von DossowVeraV, Sascha Ott, Nadine Rau, Melanie Meersch, Alexander Zarbock, and Collaborators .
• From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany (CM, MK, MM, AZ), Department of Anaesthesiology, La Fe University and Polytechnic Hospital Valencia (APM), Department of Anaesthesiology, University Hospital Vall d ́Hebron Barcelona, Spain (SGS), Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia (EG, AI), Institute of Anaesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, Ruhr- University (VvD), Department of Cardiac Anaesthesiology and Intensive Care Medicine, German Heart Center Berlin (SO, NR), Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (SO) and Department of Intensive Care Medicine, University Hospital Vall d'Hebron Barcelona, Spain.
• Eur J Anaesthesiol. 2023 Jun 1; 40 (6): 418424418-424.

BackgroundIncreasing evidence from randomised controlled trials supports the implementation of a six-measure care bundle proposed by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in patients at high risk for acute kidney injury (AKI) to reduce its incidence after cardiac surgery.ObjectiveTo assess compliance with the KDIGO bundle in clinical practice.DesignProspective observational multinational study.SettingSix international tertiary care centres, from February 2021 to November 2021.PatientsFive hundred and thirty-seven consecutive patients undergoing cardiac surgery during a 1-month observational period.InterventionsAll patients were assessed for the postoperative implementation of the following measures: avoidance of nephrotoxic medication and radiocontrast agents whenever possible, strict glycaemic control, close monitoring of renal function, optimisation of haemodynamic and volume status and functional monitoring of haemodynamic status.Main Outcome MeasuresThe primary endpoint was the proportion of patients receiving fully compliant care. Secondary outcomes were occurrence of AKI and major adverse kidney event rate at day 30.ResultsThe full care bundle was applied to 0.4% of patients. There was avoidance of nephrotoxic drugs in 15.6%, radiocontrast agents in 95.3% and hyperglycaemia in 39.6%. Close monitoring of urine output and serum creatinine was achieved in 6.3%, 57.4% underwent optimisation of volume and haemodynamic status, and 43.9% received functional haemodynamic monitoring. 27.2% developed AKI within 72 h after surgery. The average number of implemented measures was 2.6 ± 1.0 and did not differ between AKI or non-AKI patients ( P  = 0.854).ConclusionAdherence with the KDIGO bundle was very low in cardiac surgery patients. Initiatives to improve guideline compliance might provide a strategy to mitigate the burden of AKI.Trial Registrationwww.drks.de DRKS00024204.Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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