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Continuous Urine Output-Based Alert Identifies Cardiac Surgery-associated Acute Kidney Injury Earlier Than Serum
Vanessa Moll1, Manxu Zhao2, Steven Minear3
1Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN; Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA.
Journal of Cardiothoracic and Vascular Anesthesia
|July 17, 2024
Summary
Continuous urine output monitoring with the Accuryn AKI Alert system detects acute kidney injury (AKI) earlier than serum creatinine criteria. This early detection of AKI can lead to timely interventions and improved patient outcomes.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Acute kidney injury (AKI) diagnosis relies on urine output (UO) and serum creatinine (SCr), but manual UO measurement poses challenges for early detection.
- Existing methods for AKI staging can delay critical interventions.
Purpose of the Study:
- To evaluate the diagnostic performance of continuous UO monitoring with the Accuryn AKI Alert system.
- To compare the Accuryn AKI Alert system's performance against established SCr criteria for AKI staging.
- To assess the association of early AKI detection with patient outcomes.
Main Methods:
- A prospective and retrospective observational study involving 522 cardiac surgery patients across nine tertiary centers.
- Continuous UO monitoring using the Accuryn AKI Alert system was implemented.
- Comparison of AKI diagnoses based on continuous UO alerts versus traditional SCr criteria.
Main Results:
- Continuous UO alerts identified AKI stages 1 and 2 significantly earlier than SCr criteria (33.6 hours earlier for stage ≥2).
- AKI Alert demonstrated a discriminative power of 0.78 when benchmarked against SCr-based stage ≥2 AKI.
- Stage 1 AKI alerts correlated with increased ICU/hospital length of stay and need for continuous renal replacement therapy; stage ≥2 alerts were linked to mortality.
Conclusions:
- The Accuryn AKI Alert system, utilizing continuous UO, enables earlier detection of AKI stages 1 and 2 compared to SCr criteria.
- Early identification of AKI facilitates prompt kidney optimization strategies.
- Implementing continuous UO monitoring may improve patient outcomes in AKI management.
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