Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

Abstract

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

Pre-operative proteinuria, postoperative acute kidney injury and mortality

“…Thirteen studies were prospective, 16,18,19,21,44–52 and 15 studies were retrospective 17,20,22,23,53–63 . Twenty-four studies enrolled a total of 29 445 patients undergoing cardiovascular surgery 16,18,19,21–23,44,45,47–61,63 .…”

Exposure to Hyperchloremia Is Associated with Poor Early Recovery of Kidney Graft Function after Living-Donor Kidney Transplantation: A Propensity Score-Matching Analysis

“…Suetrong et al [6] suggested that the maximum serum chloride level (i.e., ≥ 110 mmol/L) and an increase ≥ 5 mmol/L within 48 hours after ICU admission due to severe sepsis or septic shock were the predominant factors associated with the development of AKI. Another study conducted by Marouli et al [12] suggested that a high intraoperative chloride load (i.e., > 500 mEq) played a significant role in the development of AKI within 48 hours after major abdominal surgery. In a prospective ICU study, a lesser intravenous chloride supply was associated with significant reduction in the worst stages of AKI and the requirement for RRT.…”

“…These harmful effects of hyperchloremia have largely been investigated in the context of chloride-rich solution resuscitation, which has been found to have a detrimental impact on kidney function [10,11]. However, the relationship between hyperchloremia and AKI has been investigated only in native (i.e., not transplanted) kidneys, in the context of clinical conditions such as sepsis, subarachnoid hemorrhage, and abdominal surgery [5,6,7,8,12].…”

Preoperative proteinuria may be a risk factor for postoperative acute kidney injury：a meta-analysis

“…The following are excluded: 10 duplicate records, 8 conference abstracts, 8 case reports, 6 notes, letters, or editorials, 18 reviews, 1 non-surgical record, 9 non-preoperative proteinuria records, 25 non-postoperative AKI records, 20 unrelated records, 1 record with children as participants, 3 nephrectomy records, and 4 records are excluded for other reasons. Therefore, we identify 10 records including 11 studies totally and report studies for our meta-analysis [14][15][16][17][18][19][20][21][22][23][24] (Figure 1).…”