scholarly journals Cardio- and Cerebrovascular Outcomes of Postoperative Acute Kidney Injury in Noncardiac Surgical Patients With Hypertension

2021 ◽  
Vol 12 ◽  
Author(s):  
Yan Guangyu ◽  
Lou Jingfeng ◽  
Liu Xing ◽  
Yuan Hong ◽  
Lu Yao
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Surgical Patients ◽  
Hypertensive Patients ◽  
Fatal Stroke ◽  
All Cause Mortality ◽  
Cerebrovascular Risk ◽  
Postoperative Aki ◽  
Fatal Myocardial Infarction

Background: The cardiovascular and cerebrovascular risk of postoperative acute kidney injury (AKI) in surgical patients is poorly described, especially in the hypertensive population.Methods: We conducted a retrospective cohort study among all hypertensive patients who underwent elective noncardiac surgery from January 1st, 2012 to August 1st, 2017 at the Third Xiangya Hospital. The primary outcomes were fatal stroke and fatal myocardial infarction (MI). The secondary outcomes were all-cause mortality.Results: The postoperative cumulative mortality within 3 months, 6 months, 1 year, 2 years, and 5 years were 1.27, 1.48, 2.15, 2.15, and 5.36%, for fatal stroke, and 2.05, 2.27, 2.70, 3.37, and 5.61% for fatal MI, respectively, in patients with postoperative AKI. Compared with non-AKI patients, those with postoperative AKI had a significantly higher risk of fatal stroke and fatal MI within 3 months [hazard ratio (HR): 5.49 (95% CI: 1.88−16.00) and 11.82 (95% CI: 4.56−30.62), respectively], 6 months [HR: 3.58 (95% CI: 1.43−8.97) and 9.23 (95% CI: 3.89−21.90), respectively], 1 year [HR: 3.64 (95% CI: 1.63−8.10) and 5.14 (95% CI: 2.50−10.57), respectively], 2 years [HR: 2.21 (95% CI: 1.03−4.72) and 3.06 (95% CI: 1.66−5.64), respectively], and 5 years [HR: 2.27 (95% CI: 1.30−3.98) and 1.98 (95% CI: 1.16−3.20), respectively]. In subgroup analysis of perioperative blood pressure (BP) lowering administration, postoperative AKI was significantly associated with 1-year and 5-year risk of fatal stroke [HR: 9.46 (95% CI: 2.85−31.40) and 3.88 (95% CI: 1.67−9.01), respectively] in patients with ACEI/ARB, and MI [HR: 6.62 (95% CI: 2.23−19.62) and 2.44 (95% CI: 1.22−4.90), respectively] in patients with CCB.Conclusion: Hypertensive patients with postoperative AKI have a significantly higher risk of fatal stroke and fatal MI, as well as all-cause mortality, within 5 years after elective noncardiac surgery. In patients with perioperative administration of ACEI/ARB and CCB, postoperative AKI was significantly associated with higher risk of fatal stroke and MI, respectively.

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 Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

2020 ◽  
Author(s):  
Henrique Tadashi katayama ◽  
Brenno Cardoso Gomes ◽  
Suzana Margareth Lobo ◽  
Renato Carneiro de Freitas Chaves ◽  
Thiago Domingos Correa ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
High Risk ◽  
Postoperative Infection ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Surgical Patients ◽  
Saps 3 ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Abstract Background: Patients who develop postoperative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after noncardiac surgery and the possible risk factors for this complication. Methods: A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after noncardiac surgery was conducted to assess whether they developed AKI. The outcomes of patients who developed AKI were then compared to those of patients who did not develop it. Results: A total of 29 ICUs participated, of which 904 involved high-risk surgical patients who were included in the study. The occurrence of AKI in the postoperative period was 15.8%, and the mortality rate of postoperative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; P= 0.001), and higher length of ICU stay (P< 0.001), length of hospital stay (P<0.001) and length of mechanical ventilator stay (P<0.001). Independent factors for the risk of developing AKI were preoperative anemia (OR=7.0; P= 0.001), SAPS 3 ( OR= 1.04, P<0.001), postoperative vasopressor use (OR= 2.47; P<0.001), postoperative infection (OR= 8.8; P<0.001), need for reoperation (OR= 7.1; P<0.001) and elective surgery (OR= 0.4; P<0.001) was protective for AKI. In addition, patients with higher perioperative fluid balance had more chance for AKI.Conclusions: AKI is associated with risk of death. Patients with anemia prior to surgery, who had a higher SAPS 3, needed a postoperative vasopressor or had postoperative infection or needed reoperation were more likely to develop AKI, as were those with a higher perioperative fluid balance.

scholarly journals Assessment of Cardiopulmonary Bypass Duration Improves Novel Biomarker Detection for Predicting Postoperative Acute Kidney Injury after Cardiovascular Surgery

2021 ◽  
Vol 10 (13) ◽  
pp. 2741
Author(s):  
Tao Han Lee ◽  
Cheng-Chia Lee ◽  
Jia-Jin Chen ◽  
Pei-Chun Fan ◽  
Yi-Ran Tu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Fatty Acid Binding Protein ◽  
Cardiovascular Surgery ◽  
Kidney Injury ◽  
Fatty Acid Binding ◽  
Discriminatory Ability ◽  
Postoperative Risk ◽  
Study Population ◽  
Postoperative Aki

Urinary liver-type fatty acid binding protein (L-FABP) is a novel biomarker with promising performance in detecting kidney injury. Previous studies reported that L-FABP showed moderate discrimination in patients that underwent cardiac surgery, and other studies revealed that longer duration of cardiopulmonary bypass (CPB) was associated with a higher risk of postoperative acute kidney injury (AKI). This study aims to examine assessing CPB duration first, then examining L-FABP can improve the discriminatory ability of L-FABP in postoperative AKI. A total of 144 patients who received cardiovascular surgery were enrolled. Urinary L-FABP levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the whole study population, the AUROC of urinary L-FABP in predicting postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively. By assessing patients according to CPB duration, the urinary L-FABP at 16 to 18 h showed more favorable discriminating ability with AUROC of 0.742. Urinary L-FABP exhibited good performance in discriminating the onset of AKI within 7 days after cardiovascular surgery. Assessing postoperative risk of AKI through CPB duration first and then using urinary L-FABP examination can provide more accurate and satisfactory performance in predicting postoperative AKI.

Association of preoperative hypoalbuminemia with postoperative acute kidney injury in patients undergoing brain tumor surgery: a retrospective study

2018 ◽  
Vol 128 (4) ◽  
pp. 1115-1122 ◽  
Author(s):  
Kyungmi Kim ◽  
Ji-Yeon Bang ◽  
Seon-Ok Kim ◽  
Saegyeol Kim ◽  
Joung Uk Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Brain Tumor ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Kidney Injury ◽  
Albumin Level ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Preoperative Serum ◽  
Postoperative Aki

OBJECTIVEHypoalbuminemia is known to be independently associated with postoperative acute kidney injury (AKI). However, little is known about the association between the preoperative serum albumin level and postoperative AKI in patients undergoing brain tumor surgery. The authors investigated the incidence of AKI, impact of preoperative serum albumin level on postoperative AKI, and death in patients undergoing brain tumor surgery.METHODSThe authors retrospectively reviewed the electronic medical records and laboratory results of 2363 patients who underwent brain tumor surgery between January 2008 and December 2014. Postoperative AKI was defined according to Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO). Multivariate logistic regression analysis was used to identify demographic, preoperative laboratory, and intraoperative factors associated with AKI development. Cox proportional hazards models were used to investigate the adjusted odds ratio and hazard ratio for the association between preoperative serum albumin level and outcome variables.RESULTSThe incidence of AKI was 1.8% (n = 43) using KDIGO criteria. The incidence of AKI was higher in patients with a preoperative serum albumin level < 3.8 g/dl (3.5%) than in those with a preoperative serum albumin level ≥ 3.8 g/dl (1.2%, p < 0.001). The overall mortality was also higher in the former than in the latter group (5.0% vs 1.8%, p < 0.001). After inverse probability of treatment-weighting adjustment, a preoperative serum albumin level < 3.8 g/dl was also found to be associated with postoperative AKI (OR 1.981, 95% CI 1.022–3.841; p = 0.043) and death (HR 2.726, 95% CI 1.522–4.880; p = 0.001).CONCLUSIONSThe authors’ results demonstrated that a preoperative serum albumin level of < 3.8 g/dl was independently associated with AKI and mortality in patients undergoing brain tumor surgery.

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

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
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.

scholarly journals Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery

2016 ◽  
Vol 124 (2) ◽  
pp. 339-352 ◽  
Author(s):  
Miklos D. Kertai ◽  
Shan Zhou ◽  
Jörn A. Karhausen ◽  
Mary Cooter ◽  
Edmund Jooste ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting ◽  
Cabg Surgery ◽  
Platelet Counts ◽  
Postoperative Aki

Abstract Background Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery. Methods The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality. Results The median postoperative nadir platelet count was 121 × 109/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 109/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P &lt; 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P &lt; 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P &lt; 0.0001). Conclusion The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.

scholarly journals Impact of Cardiac Function Improvement on Cardiac Surgery Associated Acute Kidney Injury for Patients with Preoperative Renal Dysfunction

2020 ◽  
Author(s):  
Jiarui Xu ◽  
Xin Chen ◽  
Jing Lin ◽  
Yang Li ◽  
Bo Shen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiac Function ◽  
Renal Dysfunction ◽  
Significant Risk ◽  
Kidney Injury ◽  
Normal Function ◽  
Function Group ◽  
Postoperative Aki

Abstract Background: We aim to investigate whether the postoperative cardiac function improve or not would affect the risk of cardiac surgery associated acute kidney injury (AKI) for patients with preoperative renal dysfunction. Method: Data from patients underwent cardiac surgery from April 2012 to February 2016 were collected. Renal dysfunction was defined as preoperative SCr >1.2 mg/dL (females) or >1.5 mg/dL (males). Patients were grouped as normal renal function group, renal dysfunction with chronic kidney disease (CKD group), and non CKD group. △LVEF=postoperative LVEF - preoperative LVEF. Cardiac function improved was defined as △LVEF ≥10. Patients were further divided into non CKD & cardiac function improved (non CKD+), non CKD & cardiac function not improved (non CKD-), CKD & cardiac function improved (CKD+) and CKD & cardiac function not improved (CKD-) subgroups.Results: A total of 8,661 patients were allocated as normal renal function (n=7,903), non CKD(n = 662) and CKD (n = 136) groups. Both non CKD and CKD groups had higher AKI incidence than normal function group (39.5% vs 30.0%, P < 0.001; 61.8% vs 30.0%, P<0.001), and non CKD+ group had the similar AKI incidence with normal function group (30.9% vs 30.0%, P=0.729). Multivariate logistic regression analysis revealed that non CKD-, CKD+ and CKD- were significant risk factors, whereas non CKD+ was not a significant risk factor for postoperative AKI. The SCr at discharge in non CKD+ subgroup was significantly lower than its preoperative SCr (1.4 ± 0.8 vs 1.7 ± 0.9 mg/dL, P = 0.020).Conclusions: For renal dysfunction patients with no CKD, the risk of postoperative AKI did not exist if the cardiac function improved after surgery. For CKD patients, the risk of postoperative AKI increase regardless whether the cardiac function improved or not.

scholarly journals Postoperative acute kidney injury requiring continuous renal replacement therapy and outcomes after coronary artery bypass grafting: a nationwide cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song
Keyword(s):  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Population Based ◽  
Bypass Grafting ◽  
All Cause Mortality ◽  
Postoperative Aki

Abstract Background Previous studies reported that patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiac surgery were at a higher risk of postoperative mortality. However, the impact of AKI and CRRT on long-term mortality has not yet been identified. Therefore, we investigated whether postoperative AKI requiring CRRT was associated with one-year all-cause mortality after coronary artery bypass grafting (CABG). Methods For this population-based cohort study, we analyzed data from the National Health Insurance Service database in South Korea. The cohort included all adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2017. Results A total of 15,115 patients were included in the analysis, and 214 patients (1.4%) required CRRT for AKI after CABG during hospitalization. They received CRRT at 3.1 ± 8.5 days after CABG, for 3.1 ± 7.8 days. On multivariable Cox regression, the risk of 1-year all-cause mortality in patients who underwent CRRT was 7.69-fold higher. Additionally, on multivariable Cox regression, the 30-day and 90-day mortality after CABG in patients who underwent CRRT were 18.20-fold and 20.21-fold higher than the normal value, respectively. Newly diagnosed chronic kidney disease (CKD) requiring renal replacement therapy (RRT) 1 year after CABG in patients who underwent CRRT was 2.50-fold higher. In the generalized log-linear Poisson model, the length of hospital stay (LOS) in patients who underwent CRRT was 5% longer. Conclusions This population-based cohort study showed that postoperative AKI requiring CRRT was associated with a higher 1-year all-cause mortality after CABG. Furthermore, it was associated with a higher rate of 30-day and 90-day mortality, longer LOS, and higher rate of CKD requiring RRT 1 year after CABG. Our results suggest that CRRT-associated AKI after CABG may be associated with an increased risk of mortality; hence, there should be interventions in these patients after hospital discharge.

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