Table 5.

Bundled care trials.

	Design	Outcome	Patients	Intervention	Results
PrevAKI 1 [49]	Single center prospective RCT	Primary: all KDIGO stage AKI within 72 h postop	276 patients (138 control and 138 intervention) undergoing on-pump cardiac surgery at high risk of AKI by Nephrocheck® 4 h post-CPB	Bundled care including discontinuing ACEi/ARBs, avoiding nephrotoxins, and an algorithmic approach to hemodynamic management (see text) resulting in more dobutamine, less hyperglycemia, and fewer ACEi/ARBs in intervention group	Lower rate of all-stage AKI (71.7% in control vs. 55.1% in intervention, p = 0.004, OR 0.483, 95% CI 0.293–0.796)
PrevAKI 2 [29]	Multicenter prospective RCT	Primary: adherence to bundled care	278 patients (142 control and 136 intervention) undergoing on-pump cardiac surgery at high risk of AKI by Nephrocheck® 4 h post-CPB	Bundled care including discontinuing ACEi/ARBs, avoiding nephrotoxins, and an algorithmic approach to hemodynamic management resulting in more dobutamine and more crystalloid in intervention group	Increased adherence to bundle (4.2% in control vs. 65.4% in intervention, p < 0.001, OR 42.92, 95% CI 17.61–104.60); secondary outcomes without difference in all-stage AKI (41.5% in control vs. 46.3%) but less stage 2 and 3 AKI (23.9% in control vs. 14.0%, OR 0.52, 95% CI 0.28–0.96)
Engelman [28]	QI initiative with pre- and post-implementation comparison	Primary: incidence of KDIGO stage 2 and 3 AKI	435 patients undergoing cardiac surgery before Nephrocheck® use vs. 412 patients after	Activation of kidney response team in at-risk patients (based on Nephrocheck®) which advised targeted hemodynamic management, liberalized transfusion, and avoidance of nephrotoxins; no specific algorithms or in-group treatment differences reported	Lower stage 2 and 3 AKI after implementation (2.3% pre vs. 0.24% post, p = 0.01)

QI = quality improvement.