Acute Kidney Injury after Major Abdominal Surgery: A Retrospective Cohort Analysis

Background. We analyzed the incidence, risk factors, and prognosis of acute kidney injury (AKI) in a cohort of patients undergoing major abdominal surgery.Methods. A total of 450 patients were retrospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dl or by an increase in SCr ≥ 50% and/or by a decrease in urine output to 0.5 ml/kg/hour for 6 hours, in the first 48 hours after surgery. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailedPvalue <0.05 was considered significant.Results. One hundred one patients (22.4%) had postoperative AKI. Age (adjusted odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05), nonrenal Revised Cardiac Risk Index score (adjusted OR 1.9, 95% CI 1.3–3.1,P=0.003), intraoperative erythrocytes transfusions (adjusted OR 2.2, 95% CI 1.4–3.5,P <.0001), and nonrenal Simplified Acute Physiology Score II (adjusted OR 1.03, 95% CI 1.01–1.06,P=0.0191) were associated with postoperative AKI. AKI was associated with increased in-hospital mortality (20.8% versus 2.3%,P <.0001; unadjusted OR 11.2, 95% CI 4.8–26.2,P <.0001; adjusted OR 3.7, 95% CI 1.2–11.7,P=0.024).Conclusion. AKI was common in patients undergoing major abdominal surgery and was associated with in-hospital mortality.

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Intraoperative oliguria does not predict postoperative acute kidney injury in major abdominal surgery: a cohort analysis

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0244 ◽

2020 ◽

Author(s):

Rita Inácio ◽

Joana Gameiro ◽

Solange Amaro ◽

Mafalda Duarte

Keyword(s):

Acute Kidney Injury ◽

Abdominal Surgery ◽

Hospital Mortality ◽

Urine Output ◽

Cohort Analysis ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Major Abdominal Surgery ◽

Considerable Morbidity ◽

Postoperative Aki

Abstract Background: Acute kidney injury (AKI) is a common complication in patients undergoing major abdominal surgery and is associated with considerable morbidity and mortality. Several studies investigating the association between intraoperative urine output and postoperative AKI have shown conflicting results. Here, we investigated the association of intraoperative oliguria with postoperative AKI in a cohort of patients submitted to elective major abdominal surgery. Methods: This was a single-center retrospective analysis of adult patients who underwent elective major abdominal surgery from January 2016 to December 2018. AKI was defined according to the serum creatinine criteria of the KDIGO classification. Intraoperative oliguria was defined as urine output of less than 0.5 mL/kg/h. Risk factors were evaluated using multivariate logistic regression analysis. Results: A total of 165 patients were analyzed. In the first 48 h after surgery the incidence of AKI was 19.4%. Postoperative AKI was associated with hospital mortality (p=0.011). Twenty percent of patients developed intraoperative oliguria. There was no association between preexisting comorbidities and development of intraoperative oliguria. There was no correlation between the type of anesthesia used and occurrence of intraoperative oliguria, but longer anesthesia time was associated with intraoperative oliguria (p=0.007). Higher baseline SCr (p=0.001), need of vasoactive drugs (p=0.007), and NSAIDs use (p=0.022) were associated with development of intraoperative oliguria. Intraoperative oliguria was not associated with development of postoperative AKI (p=0.772), prolonged hospital stays (p=0.176) or in-hospital mortality (p=0.820). Conclusion: In this cohort of patients we demonstrated that intraoperative oliguria does not predict postoperative AKI in major abdominal surgery.

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Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

Journal of Clinical Medicine ◽

10.3390/jcm7110431 ◽

2018 ◽

Vol 7 (11) ◽

pp. 431 ◽

Cited By ~ 5

Author(s):

Diamantina Marouli ◽

Kostas Stylianou ◽

Eleftherios Papadakis ◽

Nikolaos Kroustalakis ◽

Stavroula Kolyvaki ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Abdominal Surgery ◽

Care Center ◽

Chronic Kidney Disease Stage ◽

Tertiary Care ◽

Kidney Injury ◽

Major Abdominal Surgery ◽

Disease Stage ◽

Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

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SP279POSTOPERATIVE ACUTE KIDNEY INJURY, LONG-TERM RENAL FUNCTION AND MORTALITY IN PATIENTS UNDERGOING MAJOR ABDOMINAL SURGERY: A COHORT ANALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv190.91 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii471-iii471

Author(s):

Natacha Rodrigues ◽

Joana Gameiro ◽

Catarina Bekermen ◽

Joana Neves ◽

Maria João Melo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Abdominal Surgery ◽

Cohort Analysis ◽

Kidney Injury ◽

Major Abdominal Surgery

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Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

Journal of Clinical Medicine ◽

10.3390/jcm9082679 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2679

Author(s):

Joana Gameiro ◽

José Agapito Fonseca ◽

Filipe Marques ◽

José António Lopes

Keyword(s):

Acute Kidney Injury ◽

Abdominal Surgery ◽

Cardiovascular Events ◽

Kidney Injury ◽

Patient Characteristics ◽

Major Abdominal Surgery ◽

Comprehensive Review ◽

Postoperative Aki ◽

Long Term Mortality

Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery.

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The Impact of Propofol- and Inhalant-Based Anesthesia on Acute Kidney Injury After Major Abdominal Surgery: A Retrospective Observational Study

10.21203/rs.3.rs-39585/v1 ◽

2020 ◽

Author(s):

Bo Rim Kim ◽

Susie Yoon ◽

Gyu Young Song ◽

Seohee Lee ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Propensity Score ◽

Abdominal Surgery ◽

Kidney Injury ◽

Major Abdominal Surgery ◽

Regression Analyses ◽

Inverse Probability ◽

The Impact ◽

Postoperative Aki

Abstract Background: The optimal anesthetic for preventing postoperative acute kidney injury (AKI) remains unclear, and few studies on this topic have been conducted in the context of non-cardiac surgery. The purpose of this retrospective study was to compare propofol- and inhalant-based anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS).Methods: Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from January 2016 to December 2018 were included. Using multivariable logistic regression, the risk of postoperative AKI was compared between patients who underwent propofol-based anesthesia (propofol group) and those who received inhalant-based anesthesia (inhalant group). Additional logistic regression analyses were performed after propensity score matching and inverse probability of treatment weighting (IPTW).Results: In total, 3,616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the propofol and inhalant groups, respectively. The risk of AKI was significantly higher in the inhalant group (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.23–2.30; P= 0.001) than the propofol group. In the propensity score-matched cohort, the inhalant group had a higher risk of AKI than the propofol group (aOR, 1.68; 95% CI, 1.21–2.34; P= 0.002), and the logistic regression with IPTW showed similar results (OR, 1.74; 95% CI 1.14–1.66; P< 0.001).Conclusion: The risk of AKI after open MAS may differ significantly according to the anesthetic used. Patients receiving inhalant-based anesthesia may have a greater risk of postoperative AKI than those anaesthetized with propofol.

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