Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data

Grams, Morgan E.; Sang, Yingying; Ballew, Shoshana H.; Matsushita, Kunihiro; Molnár, Miklós; Szabó, Zoltán; Kalantar-Zadeh, Kamyar; Kövesdy, Csaba P.

doi:10.1053/j.ajkd.2015.07.022

Cited by 243 publications

(248 citation statements)

References 46 publications

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“…Grams et al examined 3.6 million veterans undergoing major cardiac, general, otolaryngologic, thoracic, vascular, urologic, and orthopedic surgery during 8 years, including 11.8% who suffered AKI by KDIGO criteria; those developing AKI stayed in the hospital nearly twice as long and were readmitted nearly twice as often as those who maintained normal renal function. 23 Alternatively, prolonged exposure to factors present within the hospital environment itself, but not captured by the VQI database, may explain diminished renal function with longer stay.…”

Section: Discussionmentioning

confidence: 99%

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Zarkowsky

Hicks

Bostock

et al. 2016

Journal of Vascular Surgery

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Objective The reported frequency of renal dysfunction after elective endovascular aneurysm repair (EVAR) varies widely in current surgical literature. Published research establishes pre-existing end-stage renal disease as a poor prognostic indicator. We intend to quantify the mortality effect associated with renal morbidity developed postoperatively and to identify modifiable risk factors. Methods All elective EVAR patients with preoperative and postoperative renal function data captured by the Vascular Quality Initiative between January 2003 and December 2014 were examined. The primary study end point was long-term mortality. Preoperative, intraoperative, and postoperative parameters were analyzed to estimate mortality stratified by renal outcome and to describe independent risk factors associated with post-EVAR renal dysfunction. Results This study included 14,475 elective EVAR patients, of whom 96.8% developed no post-EVAR renal dysfunction, 2.9% developed acute kidney injury, and 0.4% developed a new hemodialysis requirement. Estimated 5-year survival was significantly different between groups, 77.5% vs 53.5%, respectively, for the no dysfunction and acute kidney injury groups, whereas the new hemodialysis group demonstrated 22.8% 3-year estimated survival (P < .05). New-onset postoperative congestive heart failure (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.18-10.38), return to the operating room (OR, 3.26; 95% CI, 1.49-7.13), and postoperative vasopressor requirement (OR, 2.68; 95% CI, 1.40-5.12) predicted post-EVAR renal dysfunction, whereas a preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 was protective (OR, 0.33; 95% CI, 0.21-0.53). Volume of contrast material administered during elective EVAR varies 10-fold among surgeons in the Vascular Quality Initiative database, but the average volume administered to patients is statistically similar, regardless of preoperative eGFR. Multivariable logistic regression demonstrated nonsignificant correlation between contrast material volume and postoperative renal dysfunction. Conclusions Any renal dysfunction developing after elective EVAR is associated with decreased estimated long-term survival. Protecting renal function with a rational dosing metric for contrast material linked to preoperative eGFR may better guide treatment.

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Section: Discussionmentioning

confidence: 99%

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Zarkowsky

Hicks

Bostock

et al. 2016

Journal of Vascular Surgery

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“…Postoperative AKI is generally a risk factor for mortality after different kinds of surgery. 15,16 Regarding abdominal aortic surgery, Wald et al 13 already highlighted the higher risk of mortality (after both EVAR and OAR) in the presence of AKI (OR, 11.3%). Nevertheless, we could not include early mortality in the multivariate analysis because of the small number of cases in both groups.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

Castagno

Varetto

Quaglino

et al. 2016

Journal of Vascular Surgery

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Objective: The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification. Methods: We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n [ 285) or endovascular repair (n [ 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications. Results: The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P < .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P [ .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04 mg/dL; P < .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P [ .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P [ .01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P < .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P < .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P [ .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage 1. Conclusions: AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability. (J Vasc Surg 2016;64:928-33.)

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“…Among patients with AKI requiring RRT, in-hospital mortality rates ranged from 20% to 60.3% when accompanied with nonrenal organ system failure. [28,29] Several studies showed high survival rates and kidney recovery among patients who received early RRT. [30–32] Recently, a single-center trial, [25] comparing early RRT with delayed RRT in patients with AKI trial, reported that early initiation resulted in a 15.4% reduction in 90-day mortality compared with delayed RRT (39.3% vs 53.6%; P = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Early initiation of renal replacement treatment in patients with acute kidney injury

Wang

Li²,

Chu³

et al. 2016

Medicine

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Background:Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI.Methods:The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through August 2016. We searched for all eligible randomized controlled trials with regard to the role of early initiation of renal replacement treatment in mortality among patients with AKI. We extracted the following information from each study: mortality, length of stay in intensive care unit (ICU), and length of stay in hospital. Random and fixed effect models were used for pooling data.Results:Twelve trials including 1756 patients were included. The results of this meta-analysis showed that there was no significant difference between the mortality of early and delayed strategy for the initiation of renal replacement treatment using the random effect model (odds ratio = 0.78; 95% confidence interval [CI], 0.52–1.19; P = 0.25), with wild heterogeneity (chi2 = 33.50; I2 = 67%). Analyses from subgroup sepsis and postsurgery came to similar results. In addition, compared with delayed initiation strategy, early initiation showed no significant advantage in length of stay in ICU (mean difference = −0.80; 95% CI, −2.59 to 0.99; P = 0.56) and length of stay in hospital (mean difference = −7.69; 95% CI, −16.14 to 0.76; P = 0.07).Conclusion:According to the results from present meta-analysis, early initiation of renal replacement treatment showed no survival benefits in patients with AKI. To achieve optimal timing of renal replacement treatment, further large multicenter randomized trials, with widely accepted and standardized definition of early initiation, are still needed.

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Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data

Cited by 243 publications

References 46 publications

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

Early initiation of renal replacement treatment in patients with acute kidney injury

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