A narrative review of the impact of surgery and anaesthesia on acute kidney injury

Ostermann, Marlies; Cennamo, Armando; Meersch, Melanie; Kunst, Gudrun

doi:10.1111/anae.14932

Cited by 35 publications

(39 citation statements)

References 87 publications

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“…To date, in the absence of a specific therapy for post-operative AKI in AAAD patients, prevention strategies such as tight management of intraoperative hypotension and anemia, using novel technologies to reduce the duration of organ ischemia, avoidance of nephrotoxic exposure, may play an important role in renal function protection (38). More randomized controlled trials are needed to identify appropriate strategies to improve the prognosis of patients undergoing surgery for AAAD.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

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Background: Acute kidney injury (AKI) is a common complication of cardiac surgery, which could lead to increased morbidity and mortality. Acute type A aortic dissection (AAAD) is a life-threatening cardiac disease and can be closely related to post-operative AKI. However, data on the incidence of AKI defined by the newest Kidney Disease: Improving Global Outcomes (KDIGO) criteria and in-hospital mortality of a homogeneous population who underwent AAAD are limited. We aimed to investigate the incidence of AKI defined by the KDIGO criteria and the risk factors associated with the outcomes among AAAD-induced AKI patients. Methods: We reviewed 335 patients who underwent surgical treatment for AAAD between March 2009 and June 2016. We screened the patients' AKI status and analyzed probably risk factors of AKI and in-hospital mortality. Independent-sample t-test or Chi-square test was performed to identify differences between AKI and non-AKI groups and survivors with AKI and non-survivors with AKI, respectively. The logistic regression model was applied to identify independent risk factors. Results: AKI occurred in 71.94% of AAAD patients, including 85 stage 1 (35.26%), 77 stage 2 (31.95%), and 79 stage 3 (32.78%) patients. The in-hospital mortality rate was 21.16%. Logistic regression analysis showed that the body mass index, chronic kidney disease, chronic liver disease, cardiopulmonary bypass duration, red blood cell transfusion, and hypoproteinemia were the independent significant risk factors of the occurrence of post-operative AKI. The risk factors associated with in-hospital mortality among AAAD-induced AKI patients included AKI stage (odds ratio (OR), 3.322), deep hypothermic circulatory arrest (OR, 2.586), lactic acidosis (OR, 3.407), and continuous renal replacement therapy (OR, 3.156). Li et al. AKI After AAAD Surgery Conclusion: For AAAD patients undergoing surgery, AKI was a common complication, and it increased patients' mortality risk. Therefore, identifying the risk factors of AKI and preventing post-operative AKI are important for improving the post-operative outcomes of AAAD patients.

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Section: Discussionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

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“…Acute kidney injury (AKI) occurs frequently in patients after major surgeries [1][2][3]. Most data regarding AKI outcomes have come from critically ill patients or postoperative vascular and cardiac patients [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Mild Increases in Plasma Creatinine after High-Risk Abdominal Surgery Are Associated with Long-Term Renal Injury: A Retrospective Cohort Study

Joosten

Ickx

Mokhtari

et al. 2020

Preprint

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Background: The impact of mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery on long term renal function remains poorly defined. According to the “Kidney Disease: Improving Global Outcomes” (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-hour window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent moderate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI.Methods: In this single centre retrospective study, all consecutive adult patients with a plasma creatinine value ≤ 1.5 mg/dl who underwent high-risk abdominal surgery between 2014-2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a “modified” (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-hours or 1.5-1.9 times baseline) or moderate-to-severe (stage 2-3 characterised by increase in creatinine 2 to 3 times baseline or to ≥ 4.0 mg/dl). Development of long-term renal injury was compared in patients with and without postoperative AKI Results: Among the 815 patients included, 109 (13.4%) had postoperative AKI (81 mild [KDIGO 1] and 28 moderate-to-severe [KDIGO 2-3]). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P=0.190). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7-5.5]; P<0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8-11.4]; P=0.002).Conclusions: Mild AKI after high-risk abdominal surgery is associated with a higher risk of long-term renal injury one year after surgery.

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“…Some factors, such as age, race, obesity, and pre-existing diseases, are not modifiable. Others, such as prolonged surgical time, manipulation of large vessels, hemodynamic instability, and exposure to nephrotoxic drugs, are dependent on medical performance 5 .…”

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confidence: 99%

Perioperative oliguria: adequate physiological response or risk for acute kidney injury?

Mendes

Suassuna

2021

Braz. J. Nephrol.

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A narrative review of the impact of surgery and anaesthesia on acute kidney injury

Cited by 35 publications

References 87 publications

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Mild Increases in Plasma Creatinine after High-Risk Abdominal Surgery Are Associated with Long-Term Renal Injury: A Retrospective Cohort Study

Perioperative oliguria: adequate physiological response or risk for acute kidney injury?

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