scholarly journals Association of Intraoperative Hypotension with Acute Kidney Injury after Noncardiac Surgery in Patients Younger than 60 Years Old

2019 ◽  
Vol 44 (2) ◽  
pp. 211-221 ◽  
Author(s):  
Yongzhong Tang ◽  
Chaonan Zhu ◽  
Jiabin Liu ◽  
Anli Wang ◽  
Kaiming Duan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension ◽  
Outcome Relationship ◽  
Increased Risk ◽  
Interaction Factor ◽  
Surgical Duration ◽  
Postoperative Aki

Background/Aims: Intraoperative hypotension (IOH) may be associated with surgery-related acute kidney injury (AKI). However, the duration of hypotension that triggers AKI is poorly understood. The incidence of AKI with various durations of IOH and mean arterial pressures (MAPs) was investigated. Materials: A retrospective cohort study of 4,952 patients undergoing noncardiac surgery (2011 to 2016) with MAP monitoring and a length of stay of one or more days was performed. The exclusion criteria were a preoperative estimated glomerular filtration (eGFR) ≤60 mL min–1 1.73 m2–1, a preoperative MAP less than 65 mm Hg, dialysis dependence, urologic surgery, age older than 60 years, and a surgical duration of less than 60 min. The primary exposure was IOH, and the primary outcome was AKI (50% or 0.3 mg dL–1 increase in creatinine) during the first 7 postoperative days. Multivariable logistic regression was used to model the exposure-outcome relationship. Results: AKI occurred in 186 (3.76%) noncardiac surgery patients. The adjusted odds ratio for surgery-related AKI for a MAP of less than 55 mm Hg was 14.11 (95% confidence interval: 5.02–39.69) for an exposure of more than 20 min. Age was not an interaction factor between AKI and IOH. Conclusion: There was a considerably increased risk of postoperative AKI when intraoperative MAP was less than 55 mm Hg for more than 10 min. Strict blood pressure management is recommended even for patients younger than 60 years old.

Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

2015 ◽  
Vol 123 (3) ◽  
pp. 515-523 ◽  
Author(s):  
Louise Y. Sun ◽  
Duminda N. Wijeysundera ◽  
Gordon A. Tait ◽  
W. Scott Beattie
Keyword(s):  
Acute Kidney Injury ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension ◽  
Outcome Relationship ◽  
Surgical Duration ◽  
Postoperative Aki

Abstract Background: Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear. The authors investigated the association between varying periods of IOH with mean arterial pressure (MAP) less than 55, less than 60, and less than 65 mmHg with AKI. Methods: The authors conducted a retrospective cohort study of 5,127 patients undergoing noncardiac surgery (2009 to 2012) with invasive MAP monitoring and length of stay of 1 or more days. Exclusion criteria were preoperative MAP less than 65 mmHg, dialysis dependence, urologic surgery, and surgical duration less than 30 min. The primary exposure was IOH. The primary outcome was AKI (50% or 0.3 mg/dl increase in creatinine) during the first 2 postoperative days. Multivariable logistic regression was used to model the exposure–outcome relationship. Results: AKI occurred in 324 (6.3%) patients and was associated with MAP less than 60 mmHg for 11 to 20 min and MAP less than 55 mmHg for more than 10 min in a graded fashion. The adjusted odds ratio of AKI for MAP less than 55 mmHg was 2.34 (1.35 to 4.05) for 11- to 20-min exposure and 3.53 (1.51 to 8.25) for more than 20 min. For MAP less than 60 mmHg, the adjusted odds ratio for AKI was 1.84 (1.11 to 3.06) for 11- to 20-min exposure. Conclusions: In this analysis, postoperative AKI is associated with sustained intraoperative periods of MAP less than 55 and less than 60 mmHg. This study provides an impetus for clinical trials to determine whether interventions that promptly treat IOH and are tailored to individual patient physiology could help reduce the risk of AKI.

scholarly journals Analysis of intraoperative modifiable factors to prevent acute kidney injury after elective noncardiac surgery: intraoperative hypotension and crystalloid administration related to acute kidney injury

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasuma Kobayashi ◽  
Kazue Yamaoka
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Blood Pressure Range ◽  
Crystalloid Administration ◽  
Administration Protocol

Abstract Background The optimal intraoperative blood pressure range and crystalloid administration protocol for the prevention of acute kidney injury (AKI) after elective noncardiac surgery remain unknown. Methods This single-center retrospective cohort study included 6296 patients aged ≥ 50 years who had undergone elective noncardiac surgery under general anesthesia. We evaluated the relationship between duration of intraoperative hypotension and AKI. To assess whether the effects of crystalloid administration differed according to baseline estimated glomerular filtration rate (eGFR), we examined the interaction between intraoperative crystalloid administration and eGFR. We calculated univariable and multivariable adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs) for the prevalence of AKI. Results AKI occurred in 431 (6.8%) patients and was associated with intraoperative hypotension. Effects of intraoperative crystalloid administration differed significantly according to baseline eGFR. Increased risk of AKI was noted in patients with eGFR ≤45 ml min−1 1.73m−2 who were managed with restrictive or liberal crystalloid administration [OR 4.79 (95% CI 3.10 to 7.32) and 6.43 (95% CI 2.23 to 16.03), respectively] as opposed to those with eGFR >45 ml min−1 1.73m−2 who were managed with moderately restrictive crystalloid administration. Conclusions Our findings suggest that anesthesiologists should avoid intraoperative hypotension as well as either restrictive or liberal (as opposed to moderately restrictive) crystalloid administration in patients with decreased eGFR. Intraoperative blood pressure and crystalloid administration protocol are major modifiable factors that must be optimized to prevent postoperative AKI.

scholarly journals Liver Transplant Patients with High Levels of Preoperative Serum Ammonia Are at Increased Risk for Postoperative Acute Kidney Injury: A Retrospective Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1629
Author(s):  
Yoon Sook Lee ◽  
Yoon Ji Choi ◽  
Kyu Hee Park ◽  
Byeong Seon Park ◽  
Jung-Min Son ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Ammonia Level ◽  
University Hospital ◽  
Transplant Patients ◽  
Preoperative Serum ◽  
Increased Risk ◽  
Serum Ammonia ◽  
Postoperative Aki

Acute kidney injury (AKI) is one of the most frequent postoperative complications after liver transplantation (LT). Increased serum ammonia levels due to the liver disease itself may affect postoperative renal function. This study aimed to compare the incidence of postoperative AKI according to preoperative serum ammonia levels in patients after LT. Medical records from 436 patients who underwent LT from January 2010 to February 2020 in a single university hospital were retrospectively reviewed. The patients were then categorized according to changes in plasma creatinine concentrations within 48 h of LT using the Acute Kidney Injury Network criteria. A preoperative serum ammonia level above 45 mg/dL was associated with postoperative AKI (p < 0.0001). Even in patients with a normal preoperative creatinine level, when the ammonia level was greater than 45 μg/dL, the incidence of postoperative AKI was significantly higher (p < 0.0001); the AKI stage was also higher in this group than in the group with preoperative ammonia levels less than or equal to 45 μg/dL (p < 0.0001). Based on the results of our research, an elevation in preoperative serum ammonia levels above 45 μg/dL is related to postoperative AKI after LT.

scholarly journals Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032964
Author(s):  
Charlotte Slagelse ◽  
H Gammelager ◽  
Lene Hjerrild Iversen ◽  
Kathleen D Liu ◽  
Henrik T Toft Sørensen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Population Based ◽  
Adjusted Risk ◽  
Increased Risk ◽  
The Impact ◽  
Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

scholarly journals Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Adam M. Blevins ◽  
Jennifer N. Lashinsky ◽  
Craig McCammon ◽  
Marin Kollef ◽  
Scott Micek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
University Hospital ◽  
Increased Risk ◽  
Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

Caution: Increased Acute Kidney Injury in Enhanced Recovery after Surgery (ERAS) Protocols

2019 ◽  
Vol 85 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Crystal P. Koerner ◽  
Alexandra G. Lopez-Aguiar ◽  
Mohammad Zaidi ◽  
Shelby Speegle ◽  
Glen Balch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Elective Colorectal Surgery ◽  
Baseline Serum ◽  
Increased Risk ◽  
Postoperative Aki

Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P = 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3–9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6–16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5–5.8; P < 0.01). On multi-variable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5–7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P = 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.

scholarly journals Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery

2018 ◽  
Vol 35 (4) ◽  
pp. 273-279 ◽  
Author(s):  
Linn Hallqvist ◽  
Fredrik Granath ◽  
Elin Huldt ◽  
Max Bell
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension

Association of Intraoperative Hypotension With Acute Kidney Injury After Elective Noncardiac Surgery

2016 ◽  
Vol 60 (3) ◽  
pp. 120-121
Author(s):  
Louise Y. Sun ◽  
Duminda N. Wijeysundera ◽  
Gordon A. Tait ◽  
W. Scott Beattie
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension

scholarly journals Association of intraoperative hypotension with acute kidney injury after liver resection surgery: an observational cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Pingping Liao ◽  
Shuo Zhao ◽  
Lin Lyu ◽  
Xuanlong Yi ◽  
Xiangyu Ji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Liver Resection ◽  
Kidney Injury ◽  
Major Complication ◽  
Exclusion Criteria ◽  
Intraoperative Hypotension ◽  
Observational Cohort ◽  
Multivariable Regression ◽  
Postoperative Aki

Abstract Background Acute kidney injury (AKI) is a major complication following liver resection. The aim of this study was to determine the risk factors for AKI after hepatic resection and whether intraoperative hypotension (IOH) was related to AKI. Methods Adult patients (≥ 18 years) undergoing liver resection between November 2017 and November 2019 at our hospital were retrospectively reviewed. AKI was defined as ≥50% increase in serum creatinine from baseline value within 48 h after surgery. IOH was defined as the lowest absolute mean arterial pressure (MAP) < 65 mmHg for more than 10 cumulative minutes during the surgery. Patients were divided into AKI group and non-AKI group, and were stratified by age ≥ 65 years. Results 796 patients who met our inclusion and exclusion criteria were analyzed. After multivariable regression analysis, the IOH (OR, 2.565; P = 0.009) and age ≥ 65 years (OR, 2.463; P = 0.008) were risk factors for AKI. The IOH (OR, 3.547; P = 0.012) and received red blood cell (OR, 3.032; P = 0.036) were risk factors of AKI in age ≥ 65 years patients. Conclusions The IOH and age ≥ 65 years were risk factors for postoperative AKI, and IOH was associated with AKI in age ≥ 65 years patients following liver resection.

scholarly journals Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices

2017 ◽  
Vol 126 (3) ◽  
pp. 450-460 ◽  
Author(s):  
Michael R. Mathis ◽  
Subramanian Sathishkumar ◽  
Sachin Kheterpal ◽  
Matthew D. Caldwell ◽  
Francis D. Pagani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Noncardiac Surgery ◽  
Assist Device ◽  
Ventricular Assist ◽  
Intraoperative Hypotension ◽  
Left Ventricular Assist

Abstract Background Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. Methods The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. The authors described perioperative profiles of noncardiac surgery cases, including patient, left ventricular assist device, surgical case, and anesthetic characteristics, as well as staffing by cardiac/noncardiac anesthesiologists. Through univariate and multivariable analyses, the authors studied acute kidney injury as a primary outcome; secondary outcomes included elevated serum lactate dehydrogenase suggestive of left ventricular assist device thrombosis, intraoperative bleeding complication, and intraoperative hypotension. The authors additionally studied major perioperative complications and mortality. Results Two hundred and forty-six patients underwent 702 procedures. Of 607 index cases, 110 (18%) experienced postoperative acute kidney injury, and 16 (2.6%) had elevated lactate dehydrogenase. Of cases with complete blood pressure data, 176 (27%) experienced intraoperative hypotension. Bleeding complications occurred in 45 cases (6.4%). Thirteen (5.3%) patients died within 30 days of surgery. Independent risk factors associated with acute kidney injury included major surgical procedures (adjusted odds ratio, 4.4; 95% CI, 1.1 to 17.3; P = 0.03) and cases prompting invasive arterial line monitoring (adjusted odds ratio, 3.6; 95% CI, 1.3 to 10.3; P = 0.02) or preoperative fresh frozen plasma transfusion (adjusted odds ratio, 1.7; 95% CI, 1.1 to 2.8; P = 0.02). Conclusions Intraoperative hypotension and acute kidney injury were the most common complications in left ventricular assist device patients presenting for noncardiac surgery; perioperative management remains a challenge.

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