title: A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: Nitin V
authors.initials: NV
authors.lastname: Kolhe
authors.affiliation: Department of Information Management and Technology, Royal Derby Hospital, Derby, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Reilly
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: Janson
authors.initials: J
authors.lastname: Leung
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: Kirsty E
authors.initials: KE
authors.lastname: Swinscoe
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.|Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.|Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000368:Aged; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D016017:Odds Ratio; D064872:Patient Care Bundles / Q000379:methods*; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: AKI; age; care bundle; mortality; outcome