Impact of an Acute Kidney Injury Prevention Bundle in High-risk Intensive Care Unit Patients: A Single Center...

Acute kidney injury (AKI) is a frequent and serious complication in critically ill patients and is associated with increased morbidity, mortality, prolonged hospitalization, and significant healthcare costs. We evaluated the impact of an AKI prevention bundle on the incidence, severity, and outcomes in patients at high-risk of developing AKI in the intensive care unit (ICU).

In this single-center before-and-after study, high-risk patients were identified using a prediction score. A bundle comprising daily assessments, risk factor modification, nephrotoxin avoidance, hemodynamic optimization, and renal dose adjustment was implemented after a 2 months education period. Preimplementation lasted 6 months, followed by 8 months of bundle application. Outcomes including AKI incidence and severity, need for renal replacement therapy (RRT), length of ventilation days and ICU stay, and mortality were compared between pre- and post-implementation groups.

A total of 374 patients were included, 187 in the pre and 187 in the post implementation phase. The primary outcome, incidence of AKI within 72 hours of ICU admission, was lower in the post-bundle implementation group than pre-bundle implementation group (21.9 vs 27.8%); however, the difference was not statistically significant. Overall incidence of AKI was lower in the post-bundle group than in the pre-bundle group (28.9 vs 37.9%); while between 72 hours and 1week, incidences were 6.9 vs 10.1%, which were not statistically significant. Importantly, moderate-to-severe AKI was significantly reduced post-bundle implementation (13.9 vs 25.6%, p = 0.042). This group also showed significantly shorter ICU stays (6.17 vs 7.25 days, p = 0.03) and reduced mechanical ventilation duration (4.34 vs 5.30 days, p = 0.02). Renal replacement therapy requirement, 30 days mortality, and persistent renal dysfunction were lower post-bundle implementation but without statistical significance.

While the AKI prevention bundle did not significantly affect overall AKI incidence in high-risk ICU patients, it was associated with reductions in moderate-to-severe AKI, ICU stay, and duration of mechanical ventilation. A simple clinical risk score can identify patients for early intervention, and larger multicenter studies are warranted to confirm these findings.