Biomarker-guided Intervention to Prevent Acute Kidney Injury After Major Surgery

Göcze, Ivan; Jauch, Dominik; Götz, Markus; Kennedy, Pascal; Jung, Bettina; Zeman, Florian; Gnewuch, Carsten; Graf, Bernhard M.; Gnann, Wolfgang; Banas, Bernhard; Bein, Thomas; Schlitt, Hans J.; Bergler, Tobias

doi:10.1097/sla.0000000000002485

Cited by 293 publications

(264 citation statements)

References 28 publications

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“…Moreover, in the intervention group significantly lower rates of moderate and severe AKI were observed compared to the control group (29.7 vs. 44.9%; p = 0.009). Similarly, Göcze et al [30] applied a similar protocol in high-risk non-cardiac surgery patients. In patients with biomarkers values between 0.3 and 2.0, they were able to show a significantly reduced incidence of AKI 13 of 48 (27.1%) in the intervention group compared to control 24 of 50 (48.0%, p = 0.03).…”

Section: Early Diagnosis and Supportive Measures In The Postoperativementioning

confidence: 99%

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

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Background: Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients’ outcome. Summary: According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage.

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Section: Early Diagnosis and Supportive Measures In The Postoperativementioning

confidence: 99%

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

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“…Dies wurde bislang in 2 Studien an Intensivpatienten, die mittels der in den USA zur AKI-Prädiktion zugelassenen Zellzyklusarrestbiomarkern TIMP-2 und IGFBP-7 (Cut-off-Wert des Produkts aus beiden Proteinen im Urin >0,3) identifiziert wurden, evaluiert [22,48].…”

Section: Identifizierung Von Risikopatientenunclassified

“…Maßnahmenbündel zur gezielten AKIPrävention wurden bis jetzt in 2 Studien an postoperativen Patienten untersucht [22,48] …”

Section: Aki-maßnahmenbündelunclassified

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Joannidis

Klein

John

et al. 2018

Med Klin Intensivmed Notfmed

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Die akute Nierenschädigung ("acute kidney injury", AKI) ist ein komplexes Krankheitsbild, das durchschnittlich 50 % der Patienten auf Intensivstationen weltweit betrifft und mit erhöhter Morbidität und Mortalität einhergeht [32,36]. Das Spektrum der AKI reicht von einer Schädigung der Niere ohne Funktionsverlust bis zum Versagen des Organs mit der Notwendigkeit einer Nierenersatztherapie.Über die letzten Jahre wurden Diagnosekriterien für die AKI entwickelt. Die aktuellsten stellen die KDIGO-Leitlinien (KDIGO: "Kidney Disease: Improving Global Outcomes") aus dem Jahr 2012 dar, in denen auch die Klassifikation der AKI geregelt wird.

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“…For example, a recent study suggests that the protective effect of statins in patients with acute coronary syndrome undergoing coronary intervention is only seen in patients with high CRP, a parameter of inflammation that by itself is a risk factor for AKI amenable by statins [18]. Also, the improvement of kidney function with hydration is not specific to CA-AKI [19].…”

Section: Plausibilitymentioning

confidence: 99%

Contrast-associated acute kidney injury is a myth: We are not sure

2017

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Biomarker-guided Intervention to Prevent Acute Kidney Injury After Major Surgery

Abstract: Early biomarker-based prediction of imminent AKI followed by implementation of KDIGO care bundle reduced AKI severity, postoperative creatinine increase, length of ICU, and hospital stay in patients after major noncardiac surgery.

Cited by 293 publications

References 28 publications

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Prävention der akuten Nierenschädigung beim kritisch kranken Patienten

Contrast-associated acute kidney injury is a myth: We are not sure

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