Predictive role of estimated glomerular filtration rate prior to surgery in postsurgical acute kidney injury among very elderly patients: a retrospective cohort study

Abstract

Background: Acute kidney injury (AKI) is a common complication after surgery. Because of unpredictable and variable age-dependent physical decline, the incidence, risk factor of postsurgical AKI and the predictive power of estimated glomerular filtration rate prior to surgery (eGFRpreSurg) has not been fully elucidated in very elderly patients.Methods: All discharged patients aged ≥80 years without chronic kidney disease who underwent surgery prior to intensive care unit (ICU) admission from 2017 through 2018 were included. Clinical, biological and surgical data were recorded. Mean of outpatient creatinine values from the year prior to ICU admission was used as the baseline value to determine the occurrence of AKI. Postoperative AKI was diagnosed according to Kidney Disease Improving Global Outcomes criteria.Results: Among 243 very elderly postoperative patients admitted during the study period, 48 had AKI during their ICU stay. The occurrence of postsurgical AKI was associated with longer ventilation times (p < .001) and higher mortality (p < .001). The eGFRpreSurg, which is calculated based on the Modification of Diet in Renal Disease study equation, was a risk factor for postoperative AKI (OR = 2.662, p = .010). The incidence of postoperative AKI was significantly higher among patients with lower eGFRpreSurg than among those with an eGFRpreSurg ≥ 70 mL/min/1.73 m2 (p = .003).Conclusion: Postsurgical AKI in very elderly patients has a high incidence and is a risk factor for mortality. Our study confirmed that eGFRpreSurg could be used as an index for AKI risk stratification.

Acute Kidney Injury Following Coronary Artery Bypass Grafting with Cardiopulmonary Bypass at Dr. Soetomo General Academic Hospital Surabaya: A Preliminary Study

“…Glomerular filtration rate (GFR) was an important factor in determining AKI incidence in post-cardiac surgery subjects. Preoperative eGFR is a risk factor for postoperative AKI, and subjects with a preoperative eGFR of 70 mL/min/1.73m 2 have a higher incidence of AKI (26). Meta-analysis study on eGFR value before CPB operation showed a correlation between low eGFR value with AKI where preoperative GFR of <30 mL/min/1.73m 2 was a risk factor of postoperative AKI and increases the risk of AKI for more than 4,000 times (8,15,26,27).…”

Preoperative laboratory testing in elderly patients

“…According to a recent retrospective cohort study of 668 very elderly (≥80 years) patients, the estimated GFR before surgery, calculated based on the Modification of Diet in the Renal Disease Study equation, is a risk factor for postoperative AKI (OR 2.662, 95% CI 1.264–5.608; P = 0.01). The incidence of postoperative AKI is significantly higher among patients with lower preoperative estimated GFR than among those with estimated GFR ≥70 mL/min/1.73 m 2 ( P = 0.003) [ 19 ]. Although their work has many limitations in interpretation (such as neglecting various surgical burdens), late postoperative factors, AKI duration, and preoperative estimated GFR can help evaluate postoperative AKI.…”

Assessing association of preoperative estimated glomerular filtration rate with postoperative acute kidney injury in very elderly surgical patients

“…Sir, By a retrospective cohort study, Wu and colleagues [1] assessed predictive role of preoperative estimated glomerular filtration rate (eGFR) for postoperative acute kidney injury (AKI) in very elderly surgical patients and showed that eGFR could be used as an index for AKI risk stratification. This study has potential clinical implications, but we noted several issues that wished to remind readers for attention and obtain the authors' comments.…”