Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention

Background: Acute kidney injury (AKI) is associated with high morbidity and mortality; therefore, prevention is important. The aim of this study was to systematically assess AKI incidence after cardiac surgery as documented in clinical routine compared to the real incidence because AKI may be under-...

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Autores principales:	Moritz Schanz, Oliver Schöffski, Martin Kimmel, Tina Oberacker, Nora Göbel, Ulrich F. W. Franke, Mark Dominik Alscher, Markus Ketteler, Severin Schricker
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	acute kidney injury adherence to guidelines acute kidney injury awareness acute kidney injury prevention acute kidney injury undercoding acute kidney injury under-recognition cardiac surgery-associated acute kidney injury kidney disease: improving global outcomes recommendations Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/cc713b7962304fd6a26e4417221bd7c2
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spelling	oai:doaj.org-article:cc713b7962304fd6a26e4417221bd7c22021-12-02T12:40:22ZUnder-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention1420-40961423-014310.1159/000519536https://doaj.org/article/cc713b7962304fd6a26e4417221bd7c22021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/519536https://doaj.org/toc/1420-4096https://doaj.org/toc/1423-0143Background: Acute kidney injury (AKI) is associated with high morbidity and mortality; therefore, prevention is important. The aim of this study was to systematically assess AKI incidence after cardiac surgery as documented in clinical routine compared to the real incidence because AKI may be under-recognized in clinical practice. Further, its postoperative management was compared to Kidney Disease: Improving Global Outcomes (KDIGO) recommendations because recognition and adequate treatment represent the fundamental cornerstone in the prevention and management of AKI. Methods: This retrospective single-center study included n = 100 patients who underwent cardiac surgery with cardiopulmonary bypass. The coded incidence of postoperative AKI during intensive care unit stay after surgery was compared to the real AKI incidence. Furthermore, conformity of postoperative parameters with KDIGO recommendations for AKI prevention and management was reviewed. Results: We found a considerable discrepancy between coded and real incidence, and conformity with KDIGO recommendations was found to be relatively low. The coded incidence was significantly lower (n = 12 vs. n = 52, p < 0.05), representing a coding rate of 23.1%. Regarding postoperative management, 90% of all patients had at least 1 episode with mean arterial pressure <65 mm Hg within the first 72 h. Furthermore, regarding other preventive parameters (avoiding hyperglycemia, stopping angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, avoiding contrast media, and nephrotoxic drugs), only 10 patients (20.8%) in the non-AKI group and in 5 (9.6%) subjects in the AKI group had none of all the above potential AKI-promoting factors. Conclusions: AKI recognition in everyday clinical routine seems to be low, especially in lower AKI stages, and the current postoperative management still offers potential for optimization. Possibly, higher AKI awareness and stricter postoperative management could already achieve significant effects in prevention and treatment of AKI.Moritz SchanzOliver SchöffskiMartin KimmelTina OberackerNora GöbelUlrich F. W. FrankeMark Dominik AlscherMarkus KettelerSeverin SchrickerKarger Publishersarticleacute kidney injuryadherence to guidelinesacute kidney injury awarenessacute kidney injury preventionacute kidney injury undercodingacute kidney injury under-recognitioncardiac surgery-associated acute kidney injurykidney disease: improving global outcomes recommendationsDermatologyRL1-803Diseases of the circulatory (Cardiovascular) systemRC666-701Diseases of the genitourinary system. UrologyRC870-923ENKidney & Blood Pressure Research, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute kidney injury adherence to guidelines acute kidney injury awareness acute kidney injury prevention acute kidney injury undercoding acute kidney injury under-recognition cardiac surgery-associated acute kidney injury kidney disease: improving global outcomes recommendations Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	acute kidney injury adherence to guidelines acute kidney injury awareness acute kidney injury prevention acute kidney injury undercoding acute kidney injury under-recognition cardiac surgery-associated acute kidney injury kidney disease: improving global outcomes recommendations Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923 Moritz Schanz Oliver Schöffski Martin Kimmel Tina Oberacker Nora Göbel Ulrich F. W. Franke Mark Dominik Alscher Markus Ketteler Severin Schricker Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
description	Background: Acute kidney injury (AKI) is associated with high morbidity and mortality; therefore, prevention is important. The aim of this study was to systematically assess AKI incidence after cardiac surgery as documented in clinical routine compared to the real incidence because AKI may be under-recognized in clinical practice. Further, its postoperative management was compared to Kidney Disease: Improving Global Outcomes (KDIGO) recommendations because recognition and adequate treatment represent the fundamental cornerstone in the prevention and management of AKI. Methods: This retrospective single-center study included n = 100 patients who underwent cardiac surgery with cardiopulmonary bypass. The coded incidence of postoperative AKI during intensive care unit stay after surgery was compared to the real AKI incidence. Furthermore, conformity of postoperative parameters with KDIGO recommendations for AKI prevention and management was reviewed. Results: We found a considerable discrepancy between coded and real incidence, and conformity with KDIGO recommendations was found to be relatively low. The coded incidence was significantly lower (n = 12 vs. n = 52, p < 0.05), representing a coding rate of 23.1%. Regarding postoperative management, 90% of all patients had at least 1 episode with mean arterial pressure <65 mm Hg within the first 72 h. Furthermore, regarding other preventive parameters (avoiding hyperglycemia, stopping angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, avoiding contrast media, and nephrotoxic drugs), only 10 patients (20.8%) in the non-AKI group and in 5 (9.6%) subjects in the AKI group had none of all the above potential AKI-promoting factors. Conclusions: AKI recognition in everyday clinical routine seems to be low, especially in lower AKI stages, and the current postoperative management still offers potential for optimization. Possibly, higher AKI awareness and stricter postoperative management could already achieve significant effects in prevention and treatment of AKI.
format	article
author	Moritz Schanz Oliver Schöffski Martin Kimmel Tina Oberacker Nora Göbel Ulrich F. W. Franke Mark Dominik Alscher Markus Ketteler Severin Schricker
author_facet	Moritz Schanz Oliver Schöffski Martin Kimmel Tina Oberacker Nora Göbel Ulrich F. W. Franke Mark Dominik Alscher Markus Ketteler Severin Schricker
author_sort	Moritz Schanz
title	Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
title_short	Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
title_full	Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
title_fullStr	Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
title_full_unstemmed	Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention
title_sort	under-recognition of acute kidney injury after cardiac surgery in the icu impedes early detection and prevention
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/cc713b7962304fd6a26e4417221bd7c2
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Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention

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