Perioperative Acute Kidney Injury

Hobson, Charles; Ruchi, Rupam

doi:10.1016/j.ccc.2016.12.008

Cited by 76 publications

(39 citation statements)

References 128 publications

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“…Interestingly, this study found other potential risk factors for postoperative AKI, such as intraoperative vasopressor infusion, antibiotics or antiviral drug use, radiocontrast use, hydroxyethyl starch use, and exposure of anemia. Antibiotics or antiviral drug use, radiocontrast, anemia, and hydroxyethyl starch might have a role in nephrotoxicity itself, as reported in previous studies 27 . Vasopressor infusion, antiviral drugs, or hydroxyethyl starch could be used for patients who are critically ill during the perioperative period because of sepsis or shock.…”

Section: Discussionsupporting

confidence: 67%

Retrospective analysis of the association between intraoperative magnesium sulfate infusion and postoperative acute kidney injury after major laparoscopic abdominal surgery

Ryu

et al. 2019

Sci Rep

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Magnesium sulfate can be used as a co-adjuvant drug during the perioperative period and has multiple benefits. Recent evidence suggested that perioperative magnesium sulfate infusion may lower the risk of postoperative acute kidney injury (AKI). We investigated the association between intraoperative magnesium sulfate infusion and incidence of AKI after major laparoscopic abdominal surgery. We retrospectively analyzed the medical records of adult patients 20 years or older who underwent elective major laparoscopic abdominal surgery (>2 hours) between 2010 and 2016. We investigated the association between intraoperative magnesium sulfate infusion and the incidence of postoperative AKI until postoperative day (POD) 3 using a multivariable logistic regression analysis. We included 3,828 patients in this analysis; 357 patients (9.3%) received an intraoperative magnesium sulfate infusion and 186 patients (4.9%) developed postoperative AKI by POD 3. A multivariable logistic regression analysis showed that magnesium infusion was associated with a significant decrease (63%) in postoperative AKI (odds ratio, 0.37; 95% confidence interval, 0.14–0.94; P = 0.037). Our study suggested that intraoperative magnesium sulfate infusion is associated with a reduced risk of postoperative AKI until POD 3 for patients who underwent laparoscopic major abdominal surgery. Well-designed, prospective studies should be conducted to further substantiate these findings.

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Section: Discussionsupporting

confidence: 67%

Retrospective analysis of the association between intraoperative magnesium sulfate infusion and postoperative acute kidney injury after major laparoscopic abdominal surgery

Ryu

et al. 2019

Sci Rep

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“…Most of the existing risk models for acute kidney injury are focused on the general hospital population [10, 11] or are designed for critically ill patients [15]. Many of the previous risk models for surgical AKI were limited to either a specific type of surgery or the use of preoperative risk factors for statistical modeling (mainly logistic regression) with reported AUCs between 0.77 and 0.84 [1, 2, 55, 56]. The risk prediction models that have incorporated intraoperative variables are scarce and mainly focused on patients undergoing cardiac surgery with reported AUCs ranging between 0.72 and 0.81 [13, 14, 57].…”

Section: Discussionmentioning

confidence: 99%

Improved predictive models for acute kidney injury with IDEA: Intraoperative Data Embedded Analytics

et al. 2019

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Background Acute kidney injury (AKI) is a common complication after surgery that is associated with increased morbidity and mortality. The majority of existing perioperative AKI risk prediction models are limited in their generalizability and do not fully utilize intraoperative physiological time-series data. Thus, there is a need for intelligent, accurate, and robust systems to leverage new information as it becomes available to predict the risk of developing postoperative AKI. Methods A retrospective single-center cohort of 2,911 adults who underwent surgery at the University of Florida Health between 2000 and 2010 was utilized for this study. Machine learning and statistical analysis techniques were used to develop perioperative models to predict the risk of developing AKI during the first three days after surgery, first seven days after surgery, and overall (after surgery during the index hospitalization). The improvement in risk prediction was examined by incorporating intraoperative physiological time-series variables. Our proposed model enriched a preoperative model that produced a probabilistic AKI risk score by integrating intraoperative statistical features through a machine learning stacking approach inside a random forest classifier. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and Net Reclassification Improvement (NRI). Results The predictive performance of the proposed model is better than the preoperative data only model. The proposed model had an AUC of 0.86 (accuracy of 0.78) for the seven-day AKI outcome, while the preoperative model had an AUC of 0.84 (accuracy of 0.76). Furthermore, by integrating intraoperative features, the algorithm was able to reclassify 40% of the false negative patients from the preoperative model. The NRI for each outcome was AKI at three days (8%), seven days (7%), and overall (4%). Conclusions Postoperative AKI prediction was improved with high sensitivity and specificity through a machine learning approach that dynamically incorporated intraoperative data.

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“…Sepsis-induced AKI not only leads to the accumulation of various metabolites but also further causes severe clinical consequences. AKI is common and is associated with many adverse perioperative outcomes in surgical patients 4 . AKI carries a two-fold increased risk of end-stage chronic kidney disease within five years 5 .…”

Section: Introductionmentioning

confidence: 99%

Milk fat globule-epidermal growth factor 8 (MFG-E8) attenuates sepsis-induced acute kidney injury by inhibiting NF-κB signaling pathway

2019

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Purpose To explore the effect of milk fat globule-epidermal growth factor 8 (MFG-E8) on sepsis-induced acute kidney injury (SAKI). Methods Male C57BL/6 mice were randomized to control, sham, CLP, CLP+PBS, and CLP+rmMFG-E8 groups. SAKI was induced by cecal ligation and puncture (CLP). Recombinant mouse MFG-E8 (rmMFG-E8) (20 μg/kg) or PBS (vehicle) was administered intraperitoneally. Blood, urine and renal tissue were collected at 24 h after CLP. Blood samples were tested for serum kidney injury biomarker and cytokines. Urine samples were collected to detect KIM-1, and NGAL. Real-time PCR was tested for Bax and Bcl-2. TUNEL staining was used to determine renal apoptosis. Western blot was used to detect the expression of Bax, Bcl-2, and proteins in the NF-κB pathway. Results MFG-E8 alleviated SAKI by decreasing serum Cre, BUN, urine KIM-1 and NGAL and by mitigating renal pathological changes significant (p < 0.05). IL-1β, IL-6, TNF-α were significantly inhibited by MFG-E8 (p < 0.05). Apoptosis induced by SAKI was markedly suppressed by MFG-E8. Finally, MFG-E8 attenuated the activation of the NF-𝜅B signaling pathway in SAKI. Conclusion MFG-E8 has beneficial effects on SAKI, which may be achieved by inhibiting the NF-κB pathway.

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Perioperative Acute Kidney Injury

Cited by 76 publications

References 128 publications

Retrospective analysis of the association between intraoperative magnesium sulfate infusion and postoperative acute kidney injury after major laparoscopic abdominal surgery

Retrospective analysis of the association between intraoperative magnesium sulfate infusion and postoperative acute kidney injury after major laparoscopic abdominal surgery

Improved predictive models for acute kidney injury with IDEA: Intraoperative Data Embedded Analytics

Milk fat globule-epidermal growth factor 8 (MFG-E8) attenuates sepsis-induced acute kidney injury by inhibiting NF-κB signaling pathway

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