Effect of acute kidney injury care bundles on patient prognosis: a systematic review and meta-analysis

Abstract

Background: Acute kidney injury (AKI) is a severe complication among hospitalized patients. This study aimed to investigate the effect of care bundles on the prognosis of AKI patients. Methods: Electronic databases were searched from January 2012 to December 2023. Randomized controlled trials and cohort studies evaluating the effect of AKI care bundles were included. A meta-analysis using a random-effects model was conducted to explore the efficacy of the AKI care bundle. Results: A total of 12 studies with 30,152 participants were included. Based on the random-effects model, the AKI care bundles significantly improved the AKI severity (RR: 0.77, 95% CI: 0.60–0.98, I2 = 64%) and the need for renal replacement therapy (RR: 0.66, 95% CI: 0.46–0.94, I2 = 14%). However, our study did not find a statistically significant impact of AKI care bundle on the incidence of AKI incidence (RR: 0.95, 95% CI: 0.81–1.13, I2 = 87%), major adverse kidney events (RR: 1.06, 95% CI: 0.65–1.73), in-hospital mortality (RR: 0.93, 95% CI: 0.81–1.07, I2 = 19%), and length of hospital stay (MD: -0.16, 95% CI: -0.80, 0.47). Conclusion: This systematic review indicates that the implementation of the AKI bundle is a promising care model for AKI patients. There is a need for more high-quality prospective studies on AKI and patients at high risk of AKI to further determine feasible and standardized models of AKI bundle care. Clinical trial number: Not applicable.