Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

Gameiro, Joana; Fonseca, José Agapito; Neves, Marta; Jorge, Sofía; Lopes, José António

doi:10.1186/s13613-018-0369-7

Cited by 154 publications

(130 citation statements)

References 108 publications

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“…However, even though the Kidney Disease — Improving Global Outcome definition of AKI can be based upon oliguria and/or azotemia, evidence suggests that in the acute post‐operative setting, oliguria is related to less severe late adverse outcomes than azotemia, potentially due to oliguria in the post‐operative setting being relatively easily corrected by targeting hypovolaemia by monitoring and optimising circulation/perfusion. This is in line with a recent review which found urine output not to be a predictor of post‐operative AKI in elective surgery (non‐vascular, non‐cardiac, non‐transplant) . In ICU patients with acute respiratory distress syndrome (ARDS), a beneficial effect from a restrictive fluid approach including furosemide administration has been proposed; however, this population may not be directly comparable to uncomplicated PACU patients.…”

Section: Discussionsupporting

confidence: 60%

“…Post‐operative AKI varies according to procedure, perioperative risk factors and patients' factors but may occur in up to 40% of patients after major abdominal surgery with well‐documented increased risk for morbidity and mortality and diuretics are frequently used to increase urine output in patients with post‐operative oliguria . However, there is a paucity of high‐quality studies on this topic, evidenced by the fact that only four RCTs could be included for analysis in our review.…”

Section: Discussionmentioning

confidence: 99%

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Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Winther‐Olesen

Møller

Johansen

et al. 2019

Acta Anaesthesiol Scand

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Background Acute kidney injury (AKI) is associated with increased morbidity and mortality and may present as oliguria in the post‐operative phase. Diuretics, including furosemide, are commonly used in post‐operative patients. Accordingly, we aimed to assess the balance between benefits and harms of furosemide post‐operatively in adult surgical patients. Methods We conducted a systematic review with meta‐analysis according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statements, the Cochrane Handbook and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. We included randomised clinical trials (RCTs) comparing post‐operative treatment with furosemide vs no furosemide in adult surgical patients. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by conventional meta‐analysis and trial sequential analysis (TSA). Results Two thousand five hundred and sixty seven records were identified and four trials with 325 patients in total were included. All were adjudicated as having overall high risk of bias. We observed no statistically significant difference between furosemide‐ vs no furosemide‐treated patients in any of the predefined outcome measures, including AKI (RR 1.07, 95% CI 0.43‐2.65), all‐cause mortality (RR 1.73, 95% CI 0.62‐4.80, use of vasopressors post‐operatively (RR 1.04, 95% CI 0.74‐1.44) or need for renal replacement therapy (RR 3.87, 95% CI 0.44‐33.99). TSA highlighted sparse data, and the overall quality of evidence was very low. Conclusion In this systematic review, we found that the quantity and quality of evidence for using furosemide post‐operatively in adult surgical patients were very low with no firm evidence for benefit or harm.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Winther‐Olesen

Møller

Johansen

et al. 2019

Acta Anaesthesiol Scand

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“…Additionally, surgery-related factors have also been reported as risk factors for AKI, namely, the use of intravenous contrast, the use of diuretics and vasopressors, more invasive procedures, episodes of intraoperative hemodynamic instability, need for intraoperative blood transfusions, large colloid infusion during surgery, epidural anesthesia in liver resections, and emergent surgery [15]. In the univariate analysis, we reported that persistent AKI developed more frequently in patients who required urgent surgery and intraoperative vasoactive drugs.…”

Section: Discussionmentioning

confidence: 74%

“…Surgery is one of the most frequent causes associated with AKI, which accounts for up to 40% of AKI cases in hospitalized patients [5]. Reported rates of AKI in patients submitted to major abdominal surgery range from 5 to 35% [15,16]. Given the prevalence and negative impact of postoperative AKI, early recognition of AKI and distinguishing transient from persistent AKI may help optimize patient management and improve outcomes in this setting.…”

Section: Introductionmentioning

confidence: 99%

Transient and Persistent AKI and Outcomes in Patients Undergoing Major Abdominal Surgery

Gameiro

Duarte

Marques

et al. 2020

Nephron

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Introduction: Acute kidney injury (AKI) is a frequent diagnosis in surgical patients which has a detrimental effect on short-term and long-term outcomes. The purpose of this study was to evaluate the incidence and predictive factors of transient and persistent postoperative AKI in patients submitted to major abdominal surgery and to characterize the impact of AKI on in-hospital mortality. Methods: This study was a cross-examination of a retrospective analysis of clinical data of 450 patients who underwent major abdominal surgery from January 2010 to February 2011. Only AKI developing in the first 48 h after surgery was considered. AKI was diagnosed using the Kidney Disease: Improving Global Outcome (KDIGO) classification based on both serum creatinine (SCr) and urine output criteria. Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. Results: In our study, 22.4% of patients developed AKI in the first 48 h post-surgery (n = 101), and 48% of patients had persistent AKI (n = 49), defined as postoperative AKI, with a duration of more than 48 h. Older age (adjusted odds ratio [OR] 1.06 [1.00-1.11], p = 0.039), hypertension , p = 0.029), and higher preoperative SCr , p < 0.001) were independent predictors of persistent AKI. The overall in-hospital mortality was 6.4% (n = 29). Persistent AKI was associated with higher mortality than transient AKI (51.9 vs. 20.7%; p < 0.001;, p = 0.047). Conclusion: In this cohort of patients submitted to major abdominal surgery, persistent AKI was an independent predictor of in-hospital mortality in contrast to transient AKI.

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“…Postoperative acute kidney injury (AKI) is well‐recognized as a significant contributor to morbidity and mortality in patients undergoing intraabdominal general surgery and other major non‐cardiac surgery procedures . While prediction models derived from broad surgical populations are useful in defining general risk factors, specific surgical procedures may have unique aspects affecting AKI risk that are not applicable to other procedures but should nonetheless be accounted for in the development of these models.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury after hepatectomy can be reasonably predicted after surgery

Kim

Kiran

2019

J Hepato Biliary Pancreat

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Background Hepatectomy presents unique challenges potentially heightening acute kidney injury (AKI) risk, but the full spectrum of risk factors has not been identified.Methods Data for hepatectomy patients in the 2016 American College of Surgeons National Surgical Quality Improvement Program (n = 3,814) was randomly split into derivation (70%) and validation (30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5-fold above the preoperative value within 30 days of surgery. Multivariable logistic regression assessed preoperative and intraoperative risk factors for AKI. ResultsOf 2,692 patients (derivation cohort), 432 (16%) developed AKI. Risk factors were the following: age (years; adjusted odds ratio [aOR] 1.016 [95% confidence interval 1.006-1.026], female sex (aOR 0.65 [0.51-0.82]), body mass index (kg/m 2 ; aOR 1.043 [1.024-1.062]), diabetes (aOR 1.71 [1.31-2.24]), hypertension (aOR 1.66 [1.30-2.13]), hematocrit (%; aOR 0.944 [0.924-0.966]), operative time (min; aOR 1.004 [1.003-1.004]), planned open procedure (aOR 2.00 [1.47-2.73]), and Pringle maneuver (aOR 1.36 [1.07-1.72]). The areas under the curve of the receiver operating characteristic curves were 0.74 (95% CI 0.71-0.76) and 0.71 (95% CI 0.67-0.75) in the derivation and validation cohorts, respectively.Conclusions Postoperative AKI affects one in six hepatectomy patients; preoperative and intraoperative factors can predict the risk of postoperative AKI.

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Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

Cited by 154 publications

References 108 publications

Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Transient and Persistent AKI and Outcomes in Patients Undergoing Major Abdominal Surgery

Acute kidney injury after hepatectomy can be reasonably predicted after surgery

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