A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study
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 stu...
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| Format: | Article |
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Oxford University Press
2016
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| Online Access: | https://eprints.nottingham.ac.uk/42621/ |
| _version_ | 1848796529238736896 |
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| author | Kolhe, Nitin V. Reilly, Timothy Leung, Janson Fluck, Richard J. Swinscoe, Kirsty E. Selby, Nicholas M. Taal, Maarten W. |
| author_facet | Kolhe, Nitin V. Reilly, Timothy Leung, Janson Fluck, Richard J. Swinscoe, Kirsty E. Selby, Nicholas M. Taal, Maarten W. |
| author_sort | Kolhe, Nitin V. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T19:49:26Z |
| format | Article |
| id | nottingham-42621 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:49:26Z |
| publishDate | 2016 |
| publisher | Oxford University Press |
| recordtype | eprints |
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| spelling | nottingham-426212020-05-04T17:53:15Z https://eprints.nottingham.ac.uk/42621/ 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. 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. Oxford University Press 2016-05-04 Article PeerReviewed Kolhe, Nitin V., Reilly, Timothy, Leung, Janson, Fluck, Richard J., Swinscoe, Kirsty E., Selby, Nicholas M. and Taal, Maarten W. (2016) A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study. Nephrology Dialysis Transplantation, 31 (11). pp. 1846-1854. ISSN 1460-2385 age AKI care bundle mortality outcome https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfw087 doi:10.1093/ndt/gfw087 doi:10.1093/ndt/gfw087 |
| spellingShingle | age AKI care bundle mortality outcome Kolhe, Nitin V. Reilly, Timothy Leung, Janson Fluck, Richard J. Swinscoe, Kirsty E. Selby, Nicholas M. Taal, Maarten W. A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title | A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title_full | A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title_fullStr | A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title_full_unstemmed | A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title_short | A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| title_sort | simple care bundle for use in acute kidney injury: a propensity score-matched cohort study |
| topic | age AKI care bundle mortality outcome |
| url | https://eprints.nottingham.ac.uk/42621/ https://eprints.nottingham.ac.uk/42621/ https://eprints.nottingham.ac.uk/42621/ |