Prevention of Postoperative Acute Kidney Injury

Effect of a Kidney Bundle on the Occurence of Postoperative Acute Kidney Injury in Patients at Risk

Postoperative acute kidney injury (AKI) refers to increased mortality and morbidity in patients after non-cardiac surgery. The Kidney Disease Improving Global Outcomes (KDIGO)-guidelines recommend a bundle of procedures to prevent the occurrence of AKI: A protocol for the improvement of the hemodynamic situation and a standardized proceeding in hemodynamic monitoring, consequent avoidance of nephrotoxic substances, regular measurement of creatinine and urine output, as well as normoglycemia. The primary goal is to determine if the consequent application of the KDIGO-bundle leads to a prevention of the occurrence of AKI in patients at risk after non-cardiac surgery.

All patients included in the study will be treated with the KDIGO-bundle (hemodynamic stabilization, avoidance of nephrotoxic substances, normoglycemia and measurement of creatinine in serum and urine output). 12 h, 24h as well as on day 2, 3, 5 and 10 after admission on ICU the occurence of AKI (according to KDIGO) will be assessed.

Inclusion criteria:

• Age > 65 years
• chronic kidney disease
• diabetes mellitus, chronic heart, lung or liver disease
• hemodynamic instability (intra and/or post-operative)
• trauma, burn injury, major surgery, usage of x-ray contrast and sepsis.

Exclusion criteria:

• Age < 18 years
• pregnancy
• kidney graft recipient
• chronic renal disease with or without renal replacement therapy and cardiac surgery.