Semester

Summer

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Kellon Smith

Committee Member

Mohammed Quazi

Committee Member

Anthony Dempsey

Abstract

Abstract

NephroCheck Implementation and its Impact on the Incidence of Acute Kidney Injury After Coronary Artery Bypass Graft Surgery

Michael C. MacCourtney

Problem Statement: Acute kidney injury occurs in up to 50% of patients after cardiac surgery (Meersche et al., 2017). This contributes to significant morbidity, mortality, and costs (Helgadottir et al., 2016). At the time of the project implementation, the standard of care involved measuring renal function utilizing serum creatinine (SCr) and urine output (UOP) without NephroCheck. These renal function labs do not represent a timely and accurate assessment of the patient’s current renal status because they do not show a change until days after the patient’s initial renal injury (Nalesso et al., 2020).This delays interventions (Nalesso et al., 2020).

Background: Acute kidney injury (AKI) development after coronary artery bypass graft surgery (CABG) is a common occurrence that contributes to significant morbidity, mortality, and costs (Helgadottir et al., 2016). Prevention of long-term complications involves identification of patients at risk for AKI and optimizing their fluid status (Helgadottir et al., 2016). Based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, optimizing fluid status generally involves administering intravenous fluids (IVF) in response to serum creatinine (SCr) and urine output (UOP) levels (KDIGO, 2012). However, these renal function parameters are insufficient in the monitoring of AKI as they may not change or respond to the noxious stimuli during CABG until days after surgery which impacts timely intervention strategies (Nalesso et al., 2020). The urinary biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin growth factor-binding protein 7 (IGFBP7) have been used to identify renal pathology sooner than SCr and UOP (Wen & Parikh, 2021). NephroCheck is an immunoassay test that measures the urinary concentrations of TIMP-2 and IGFBP7 and was approved by the Food and Drug Administration (FDA) in 2014 (Nalesso et al., 2020).

Project Goal: The purpose of this project is to incorporate NephroCheck in the Open Heart ICU setting at a community hospital in West Virginia and examine the incidence of moderate to severe AKI in CABG patients after implementation.

Project Aims: 1. Evaluate the current practice for assessing renal function in CABG patients. 2. Implement project that adopts NephroCheck as the standard of care. 3. Evaluate the results of the project after six months of NephroCheck implementation.

Methods: Deidentified quarterly reports based on Society of Thoracic Surgeon (STS) renal failure data were utilized to examine the incidence of moderate to severe AKI and dialysis before and after incorporation of NephroCheck. Statistical analysis including independent t-testing and Mann-Whitney U testing was utilized to compare the results. Likert-style surveys were administered to staff during an initial debriefing to ensure staff understood how to collect the NephroCheck lab.

Implementation: Meetings with CVT intensivist to adopt NephroCheck as the standard of care and review deidentified quarterly reports based on STS Renal Failure data.

Results: Statistical analysis was utilized to compare the means before and after implementation of NephroCheck. Independent t-test and Mann-Whitney U test were used to compare the means. During the pre-intervention period, the mean percentage of renal failure was 1.69%. The mean percentage of renal failure during the post-intervention period was 1.19%. Statistical comparison of pre-intervention (M = 1.68, SD = 1.55) to post-intervention (M = 1.43, SD = 1.06, t = .307, p = .104) (U = 12, p = .916) showed a decrease in the percentage of renal failure but the results were not statistically significant. The mean percentage of dialysis during the pre-intervention period was .806%. The mean percentage of dialysis during the post-intervention period was .580%. Statistical comparison of pre-intervention (M = .806, SD = 1.17) to post-intervention (M = .580, SD = .795, t = .358, p = .235) (U = 12, p = .916) showed a decrease in the percentage of dialysis but the results were not statistically significant.

Conclusions: Evidence suggests utilization of NephroCheck can decrease the incidence of moderate to severe AKI. The results of this project produced a decrease in moderate to severe AKI and dialysis. However, the results were not statistically significant.

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