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A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study

Kolhe, Nitin V.; Reilly, Timothy; Leung, Janson; Fluck, Richard J.; Swinscoe, Kirsty E.; Selby, Nicholas M.; Taal, Maarten W.

Authors

Nitin V. Kolhe

Timothy Reilly

Janson Leung

Richard J. Fluck

Kirsty E. Swinscoe

Nicholas M. Selby

Maarten W. Taal



Abstract

Background

Consensus guidelines for acute kidney injury (AKI) have recommended prompt treatment including attention to fluid balance, drug dosing and avoidance of nephrotoxins. These simple measures can be incorporated in a care bundle to facilitate early implementation. The objective of this study was to assess the effect of compliance with the AKI care bundle (AKI-CB) on in-hospital case–fatality and AKI progression.
Methods

In this larger, propensity score-matched cohort of multifactorial AKI, we examined the impact of compliance with an AKI-CB in 3717 consecutive episodes of AKI in 3518 patients between 1 August 2013 and 31 January 2015. Propensity score matching was performed to match 939 AKI events where the AKI-CB was completed with 1823 AKI events where AKI-CB was not completed.
Results

The AKI-CB was completed in 25.6% of patients within 24 h. The unadjusted case–fatality was higher when the AKI-CB was not completed versus when the AKI-CB was completed (24.4 versus 20.4%, P = 0.017). In multivariable analysis, AKI-CB completion within 24 h was associated with lower odds for in-hospital death [odds ratio (OR): 0.76; 95% confidence interval (95% CI): 0.62–0.92]. Increasing age (OR: 1.04; 95% CI: 1.03–1.05), hospital-acquired AKI (OR: 1.28; 95% CI: 1.04–1.58), AKI stage 2 (OR: 1.91; 95% CI: 1.53–2.39) and increasing Charlson's comorbidity index (CCI) [OR: 3.31 (95% CI: 2.37–4.64) for CCI of more than 5 compared with zero] had higher odds for death, whereas AKI during elective admission was associated with lower odds for death (OR: 0.29; 95% CI: 0.16–0.52). Progression to higher AKI stages was lower when the AKI-CB was completed (4.2 versus 6.7%, P = 0.02).
Conclusions

Compliance with an AKI-CB was associated with lower mortality and reduced progression of AKI to higher stages. The AKI-CB is simple and inexpensive, and could therefore be applied in all healthcare settings to improve outcomes.

Citation

Kolhe, N. V., Reilly, T., Leung, J., Fluck, R. J., Swinscoe, K. E., Selby, N. M., & Taal, M. W. (2016). A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study. Nephrology Dialysis Transplantation, 31(11), https://doi.org/10.1093/ndt/gfw087

Journal Article Type Article
Acceptance Date Mar 21, 2016
Publication Date May 4, 2016
Deposit Date May 9, 2017
Publicly Available Date Mar 28, 2024
Journal Nephrology Dialysis Transplantation
Print ISSN 0931-0509
Electronic ISSN 1460-2385
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 31
Issue 11
DOI https://doi.org/10.1093/ndt/gfw087
Keywords age, AKI, care bundle, mortality, outcome
Public URL https://nottingham-repository.worktribe.com/output/791523
Publisher URL https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfw087