Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery

<b>Background:</b> The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protec...

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Autores principales:	Laszlo Halmy, Joshua Riedel, Florian Zeman, Birgit Tege, Volker Linder, Carsten Gnewuch, Bernhard M. Graf, Hans J. Schlitt, Tobias Bergler, Ivan Göcze
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	AKI major surgery electronic alert biomarker recovery Medicine R
Acceso en línea:	https://doaj.org/article/c2971466012e485db34efdd05032d361
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spelling	oai:doaj.org-article:c2971466012e485db34efdd05032d3612021-11-11T17:44:34ZRenal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery10.3390/jcm102151222077-0383https://doaj.org/article/c2971466012e485db34efdd05032d3612021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5122https://doaj.org/toc/2077-0383<b>Background:</b> The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protection strategy implemented in the routine care may have an impact on the incidence of early complete reversal of AKI after major non-cardiac surgery. <b>Methods:</b> We studied 294 patients in two cohorts before (<i>n</i> = 151) and after protocol implementation (<i>n</i> = 143). Data collection required 6 months for each cohort. The kidney-protection protocol included an electronic alert to detect patients who were eligible for urinary biomarker [TIMP2 × IGFBP7]-guided kidney-protection intervention. Intervention was stratified according to three levels of immediate AKI risk: low, moderate, and high. After intervention, postoperative changes in the glomerular filtration rate (eGFR) were identified with a tracking software that included an alert for nephrology consultation if the eGFR had declined by >25% from the preoperative reference value. Primary outcome was early AKI recovery, i.e., the complete reversal of any AKI stage to absence of AKI within the first 7 postoperative days. <b>Results:</b> Protocol implementation significantly increased the recovery of AKI (36/46, 78% compared to control 27/48, 56%, (<i>p</i> = 0.025)) and reduced the length of the ICU stay (<i>p</i> < 0.001). There was no significant difference in the overall incidence of all AKI and moderate and severe AKI in the first 7 postoperative days: 46/143 (32%) and 12/151 (8%) in the protocol implementation group compared to 48/151 (32%) and 18/151 (12%) in the historical control group. Patients with AKI reversal within the first 7 postoperative days had lower in-hospital mortality than patients without AKI reversal. <b>Conclusions:</b> Implementing a combined electronic alert and biomarker-guided kidney-protection strategy in routine care improved early recovery of AKI after major surgery.Laszlo HalmyJoshua RiedelFlorian ZemanBirgit TegeVolker LinderCarsten GnewuchBernhard M. GrafHans J. SchlittTobias BerglerIvan GöczeMDPI AGarticleAKImajor surgeryelectronic alertbiomarkerrecoveryMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5122, p 5122 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	AKI major surgery electronic alert biomarker recovery Medicine R
spellingShingle	AKI major surgery electronic alert biomarker recovery Medicine R Laszlo Halmy Joshua Riedel Florian Zeman Birgit Tege Volker Linder Carsten Gnewuch Bernhard M. Graf Hans J. Schlitt Tobias Bergler Ivan Göcze Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
description	<b>Background:</b> The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protection strategy implemented in the routine care may have an impact on the incidence of early complete reversal of AKI after major non-cardiac surgery. <b>Methods:</b> We studied 294 patients in two cohorts before (<i>n</i> = 151) and after protocol implementation (<i>n</i> = 143). Data collection required 6 months for each cohort. The kidney-protection protocol included an electronic alert to detect patients who were eligible for urinary biomarker [TIMP2 × IGFBP7]-guided kidney-protection intervention. Intervention was stratified according to three levels of immediate AKI risk: low, moderate, and high. After intervention, postoperative changes in the glomerular filtration rate (eGFR) were identified with a tracking software that included an alert for nephrology consultation if the eGFR had declined by >25% from the preoperative reference value. Primary outcome was early AKI recovery, i.e., the complete reversal of any AKI stage to absence of AKI within the first 7 postoperative days. <b>Results:</b> Protocol implementation significantly increased the recovery of AKI (36/46, 78% compared to control 27/48, 56%, (<i>p</i> = 0.025)) and reduced the length of the ICU stay (<i>p</i> < 0.001). There was no significant difference in the overall incidence of all AKI and moderate and severe AKI in the first 7 postoperative days: 46/143 (32%) and 12/151 (8%) in the protocol implementation group compared to 48/151 (32%) and 18/151 (12%) in the historical control group. Patients with AKI reversal within the first 7 postoperative days had lower in-hospital mortality than patients without AKI reversal. <b>Conclusions:</b> Implementing a combined electronic alert and biomarker-guided kidney-protection strategy in routine care improved early recovery of AKI after major surgery.
format	article
author	Laszlo Halmy Joshua Riedel Florian Zeman Birgit Tege Volker Linder Carsten Gnewuch Bernhard M. Graf Hans J. Schlitt Tobias Bergler Ivan Göcze
author_facet	Laszlo Halmy Joshua Riedel Florian Zeman Birgit Tege Volker Linder Carsten Gnewuch Bernhard M. Graf Hans J. Schlitt Tobias Bergler Ivan Göcze
author_sort	Laszlo Halmy
title	Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
title_short	Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
title_full	Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
title_fullStr	Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
title_full_unstemmed	Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery
title_sort	renal recovery after the implementation of an electronic alert and biomarker-guided kidney-protection strategy following major surgery
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c2971466012e485db34efdd05032d361
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Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery

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