Effect of Prophylactic Care Bundle on Acute Kidney Injury Following Coronary Artery Bypass Grafting

BACKGROUNDAcute kidney injury (AKI) following cardiac surgery is common, yet no consistently effective preventive strategy has been established. Therefore, the aim of this study was to assess the effectiveness of perioperative care bundle in preventing AKI following cardiac surgery. METHODSThe study included consecutive low-risk and high-risk patients who underwent coronary artery bypass grafting (CABG) at China National Center for Cardiovascular Diseases from January 1, 2020, to September 30, 2022. The intervention consisted of a structured care bundle based on Kidney Disease: Improving Global Outcomes guidelines, including close hemodynamic monitoring, goal-directed fluid management, avoidance of nephrotoxins, temporary discontinuation of angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers for 48 h, serial monitoring of serum creatinine and urine output, and prevention of hyperglycemia. The primary outcome was AKI within 7 days post-surgery. The secondary outcome was in-hospital major adverse cardiac and kidney events (composite of death, renal replacement therapy, >200% creatinine increase, myocardial infarction, or stroke). RESULTSOf 8,603 patients (2,462 receiving bundle care; 6,141 usual care), 2,416 propensity-matched pairs were analyzed. Mean age was 60.2 years (bundle: standard deviation [SD] 8.9; usual care: SD 9.0); 16.5% vs. 16.3% were women. AKI risk was significantly lower with bundle care vs. usual care (53.1% vs. 59.9%; mean difference, -6.8% [95% confidence interval (CI), -9.6% to -0.4%]; relative risk [RR], 0.89 [95% CI, 0.84 to 0.93]; P < .001). Bundle care also reduced major adverse cardiac and kidney events (4.7% vs. 6.3%; mean difference, -1.6% [95% CI, -2.9% to -0.3%]; RR, 0.75 [95% CI, 0.59 to 0.95]; P = .02). Benefits were more pronounced in high-risk patients (for AKI, RR, 0.89 [95% CI, 0.84 to 0.95]; P < .001; for major adverse cardiac and kidney events, RR, 0.74 [95% CI, 0.55 to 1.00]; P = .04). No statistically significant difference in all-cause mortality was observed. CONCLUSIONSAmong patients undergoing CABG, perioperative care bundle strategy, compared with standard care, was significantly associated with a lower risk of AKI and in-hospital major adverse cardiac and kidney events. Randomized clinical trials are warranted to confirm these findings.