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Abstract: PO0061

The Effect of Care Bundles for AKI: A Systematic Review and Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Chen, Yixin, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
  • Zhou, Fangfang, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
  • Luo, Qun, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
Background

Acute kidney injury (AKI) is common and associated with increased morbidity and mortality. Implementation a set of evidence-based AKI care bundles may have some benefits to patient outcomes by reducing variable standards of care. We aimed to systematically review the literature to quantify the effect of AKI care bundles on patient outcomes.

Methods

We searched Pubmed (Medline), EMBASE and Cochrane databases for studies that compare the effect of AKI care bundles with usual standard care in patients with or at risk of AKI from database inception to December 31, 2019. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Heterogeneity was assessed using Cochrane Q test and I2 test statistics. Data were analyzed by RevMan 5.3 and Comprehensive meta-analysis (CMA 3.0). The primary outcome was in-hospital or longest follow-up mortality. Secondary outcomes included AKI incidence and AKI severity.

Results

A total of 11 studies (23,491 patients) were included in the meta-analysis. The implementation of AKI care bundles significantly reduced mortality in all patients (odds ratio, 0.87; 95% CI, 0.79–0.94; P =0.001; I2 = 0%; Fig 1). And in patients at high risk for AKI(identified by novel biomarker, risk prediction score or electronic alert), care bundles significantly reduced AKI incidence(odds ratio, 0.62; 95% CI, 0.44–0.86; P=0.005; I2 = 70%; Fig 2) and rates of AKI severity (odds ratio, 0.52; 95% CI, 0.35–0.76; P＜0.001; I2= 41%; Fig 3). In addition, there was no evidence of publication bias among the included studies.

Conclusion

The introduction of AKI care bundles can effectively improve outcome in patients with or at risk of AKI, especially when combined with novel biomarker, risk prediction score or electronic alert to manage AKI at early stage. However, the evidence so far is limited and not strong enough to make definite conclusions.