Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

Abstract

Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

Risk factors for acute kidney injury after major abdominal surgery in the elderly aged 75 years and above

“…In our analysis, about 8% of patients did not have an available SCr value before and after surgery. Romagnoli et al [18] demonstrated that 14% of patients undergoing a scheduled major abdominal surgery did not have SCr values available. Efforts to obtain SCr values should be made before and after scheduled surgeries to assess patient's kidney function and to prevent the occurrence of kidney injury, especially in elderly patients.…”

Doppler-Derived Renal Functional Reserve in the Prediction of Postoperative Acute Kidney Injury in Patients Undergoing Robotic Surgery

“…Preoperative measurement of sCr is nowadays the standard of practice to quantify the preoperative patient’s renal function and risk for developing PO-AKI. 17 eGFR has been proposed to better inform the physician on the baseline patient’s kidney function, also given the availability of valid data of the GFR measured in people of different races. 18 Accordingly, in our study, both sCr and eGFR predict PO-AKI with a ROC-AUC of 0.85 (95% CI, 0.74–0.97, P = .007) and 0.84 (95% CI, 0.71–0.96, P = .006), respectively.…”