Prevention of renal dysfunction in postoperative elderly patients

Mårtensson, Jerker; Bellomo, Rinaldo

doi:10.1097/mcc.0000000000000107

Cited by 14 publications

(13 citation statements)

References 54 publications

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“…Elderly patients are particularly susceptible to developing AKI. Anatomical and physiological changes in the aging kidney, increased burden of comorbidities, more frequent exposure to medications, and changes in drug metabolism are suspected to contribute to the increased risk of AKI in the elderly [6,8,16,17,19–23]. AKI following hip fracture has multi-factorial causes.…”

Section: Discussionmentioning

confidence: 99%

“…The structural and functional changes associated with aging increase the risk of AKI in elderly populations. Age older than 65 years is a risk factor for non-recovery from AKI and even progression to chronic kidney disease [6,16,19,21–23]. The long-term survival of patients with AKI is poor and gets worse with increasing age and even AKI that does not require dialysis is associated with increased mortality [24–27].…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery

et al. 2017

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BackgroundHip fracture is a common health problem in the elderly that is associated with increased mortality. Acute kidney injury (AKI) is a frequent complication in elderly patients undergoing surgery and is associated with the clinical outcome. We evaluated the incidence and risk factors of AKI in elderly patients undergoing hip fracture surgery and the impact of AKI on short- and long-term clinical outcomes.MethodsWe performed a retrospective cohort study of 450 elderly patients who underwent hip fracture surgery between January 2010 and December 2012. We defined AKI according to the Acute Kidney Injury Network (AKIN) criteria and investigated the effect of AKI on the duration of hospital stay and in-hospital and long-term mortality.ResultsOf the 450 patients, 95 (21.1%) developed AKI during hospitalization and 178 (39.6%) died, with a mean follow-up of 3.6 ± 1.0 years. The baseline serum creatinine level, use of angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists, red blood cell transfusion volume, and history of coronary artery disease were independent risk factors for AKI. Patients with AKI during hospitalization had significantly longer hospital stays and higher in-hospital and long-term mortality than those without AKI. Multivariate analysis revealed that age, history of coronary artery disease, serum albumin level, and AKI were independent predictors of long-term mortality.ConclusionsAKI is a frequent complication in elderly patients undergoing hip fracture surgery and is independently associated with increased in-hospital and long-term mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery

et al. 2017

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“…This is often seen in elderly patients without overt renal disease (when evaluated by serum creatinine concentration), especially in the postoperative period (see Section 3.2.2.) [35].…”

Section: Pharmacodynamics and Pharmacokinetics Of Antihaemostatic Drugsmentioning

confidence: 99%

“…There is further an age-related decrease in GFR that may be as much as 1.1 mL/min per year from 30 years of age [66]. Elderly (>65 years) also carry a higher risk of acquiring acute kidney injury in the postoperative period [35].…”

Section: Renal Impairmentmentioning

confidence: 99%

Reducing risk of spinal haematoma from spinal and epidural pain procedures

Breivik

Norum

Fenger-Eriksen

et al. 2018

Scandinavian Journal of Pain

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Abstract Background and aims: Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. Methods: We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Results and recommendations: Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients’ comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. Conclusions: When neuraxial analgesia is considered for a patient on anti-haemostatic medication, with patient-related, or procedure-related risk factors, the balance of benefits against risks of bleeding is decisive; when CNB are offered exclusively to patients who will have a reduction of postoperative morbidity and mortality, then a higher risk of bleeding may be accepted. Robust routines should ensure appropriate discontinuation of anti-haemostatic drugs and early detection and treatment of SH. Implications: There is an on-going development of drugs for prevention of thromboembolic events following surgery and childbirth. The present practise advisory provides up-to-date knowledge and experts’ experiences so that patients who will greatly benefit from neuraxial pain procedures and have increased risk of bleeding can safely benefit from these procedures. There are always individual factors for the clinician to evaluate and consider. Increasingly it is necessary for the anaesthesia and analgesia provider to collaborate with specialists in haemostasis. Surgeons and obstetricians must be equally well prepared to collaborate for the best outcome for their patients suffering from acute or chronic pain. Optimal pain management is a prerequisite for enhanced recovery after surgery, but there is a multitude of additional concerns, such as early mobilisation, early oral feeding and ileus prevention that surgeons and anaesthesia providers need to optimise for the best outcome and least risk of complications.

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“…Medications that block the renin-angiotensin-aldosterone system and non-steroidal anti-inflammatory drugs increase the risk of postoperative AKI [5455]. The influence on the compensatory mechanism that maintains the GFR under hemodynamically compromised conditions is the main mechanism for this increased risk.…”

Section: Risk Factorsmentioning

confidence: 99%

Postoperative acute kidney injury

Park

2017

Korean J Anesthesiol

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Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Several definitions of AKI have been proposed recently, and include both increases in serum creatinine levels and decreases in urine output as diagnostic criteria. The pathophysiology of postoperative AKI is complex and involves both ischemic injury and systemic inflammation. Identifying risk factors, such as old age, underlying diabetes, heart failure, and obesity, may aid in the application of preventative methods for postoperative AKI. Additionally, recognizing different risks after different types of surgical procedures would be valuable. Novel biomarkers that could detect AKI more precisely at an earlier time point are being investigated. Several new biomarkers have been assessed in large multi-center studies and are believed to accommodate conventional clinical findings in diagnosing postoperative AKI. In high-risk patients, preventative measures, such as the maintenance of adequate hemodynamics and sufficient fluid resuscitation, could lower the incidence of postoperative AKI. Avoiding nephrotoxic agents and optimizing preoperative hemoglobin levels to avoid excessive transfusions would also be beneficial. In situations in which medical management fails to maintain sufficient urine output and acid–base and electrolyte homeostasis, early initiation of renal replacement therapy should be considered.

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Prevention of renal dysfunction in postoperative elderly patients

Cited by 14 publications

References 54 publications

Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery

Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery

Reducing risk of spinal haematoma from spinal and epidural pain procedures

Postoperative acute kidney injury

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