Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
Küçük Resim Yok
Tarih
2024
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Springer Science and Business Media Deutschland GmbH
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors. © The Author(s) 2024.
Açıklama
Anahtar Kelimeler
Acute kidney disease, Acute kidney injury, Chronic kidney disease, Postoperative, Surgery, Acute Disease, Acute Kidney Injury, Humans, Kidney, Prospective Studies, Renal Insufficiency, Chronic, acetylsalicylic acid, aminoglycoside, angiotensin receptor antagonist, beta adrenergic receptor blocking agent, contrast medium, cyclosporine, dipeptidyl carboxypeptidase inhibitor, diuretic agent, epinephrine, hydroxymethylglutaryl coenzyme A reductase inhibitor, hypertensive factor, nonsteroid antiinflammatory agent, noradrenalin, tacrolimus, vancomycin, acute kidney failure, adult, American Society of Anaesthesiologists score, Article, atrial fibrillation, bronchospasm, cerebrovascular accident, chronic kidney failure, chronic obstructive lung disease, clinical outcome, clinical trial (topic), cohort analysis, comorbidity, congestive heart failure, controlled study, creatinine blood level, death, diabetes mellitus, disease duration, disease exacerbation, disease severity, drug exposure, estimated glomerular filtration rate, female, heart atrium flutter, heart infarction, heart surgery, human, hypertension, major clinical study, major surgery, male, middle aged, multicenter study, observational study, perioperative period, peripheral vascular disease, pneumonia, postoperative care, postoperative complication, prospective study, pulmonary aspiration, risk factor, secondary analysis, sepsis, survivor, urologic surgery, vascular surgery, acute disease, acute kidney failure, chronic kidney failure, clinical trial, kidney
Kaynak
Intensive Care Medicine
WoS Q Değeri
Scopus Q Değeri
Q1
Cilt
50
Sayı
2
