Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis

Meaning and Management of Perioperative Oliguria

“…11 In a meta-analysis including 17,148 patients undergoing noncardiac surgery, intraoperative oliguria increased postoperative AKI risk (urine output less than 0.5 ml · kg −1 · h −1 ; odds ratio, 1.74; 95% CI, 1.36 to 2.23; P < 0.0001). 12 In the Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) trial, intraoperative oliguria (urine output less than 0.5 ml · kg −1 · h −1 for 1 h or more) was associated with postoperative AKI (risk ratio, 1.38; 95% CI, 1.14 to 1.44; P < 0.001). 1 However, the positive predictive value of intraoperative oliguria was low (25.5%), and 74% of the patients with postoperative AKI did not present intraoperative oliguria.…”

“…1,2,4,5 The release of cortisol in response to surgical stress or exogenous administration of steroids (e.g., dexamethasone for postoperative nausea and vomiting) can increase sodium and water retention, as can volatile anesthetics. 12,13 Surgery and anesthesia can also alter renal perfusion via systemic hemodynamics. Anesthesia-induced vasodilation, bleeding, and hypovolemia can decrease venous return, cardiac output, and oxygen transport.…”

“…Most studies of intraoperative oliguria have not found significant association with mortality. 1,4,11,12 Among 3,560 patients undergoing abdominal surgery, the inclusion of intraoperative urine output of less than 0.3 ml · kg −1 · h −1 for 1 h or more in a statistical model to predict postoperative AKI (defined by KDIGO criteria, based on an increase in serum creatinine of 26.5 mmol/l or more within 48 h or 1.5 times baseline or more within 7 days after surgery) led to an improvement in the risk stratification (net reclassification improvement, 0.159; 95% CI, 0.049 to 0.270; P = 0.005). 11 In a meta-analysis including 17,148 patients undergoing noncardiac surgery, intraoperative oliguria increased postoperative AKI risk (urine output less than 0.5 ml · kg −1 · h −1 ; odds ratio, 1.74; 95% CI, 1.36 to 2.23; P < 0.0001).…”

“…1,2,4,5 The release of cortisol in response to surgical stress or exogenous administration of steroids ( e.g ., dexamethasone for postoperative nausea and vomiting) can increase sodium and water retention, as can volatile anesthetics. 12,13…”

“…14,25 Sepsis leads to intrarenal microcirculatory defects, regional and systemic inflammatory cell infiltration, and apoptosis-promoting AKI. 12,19 Patients with surgical site infection or pneumonia have increased odds of developing AKI (odds ratio, 10.5 [95% CI, 3.8 to 29.3; P < .001] and odds ratio, 11.8 [95% CI, 7.7 to 18.3; P < .001], respectively). 25 In rare cases, interstitial nephritis can occur in the perioperative setting after certain medication exposures (e.g., nonsteroidal anti-inflammatory drugs, antibiotics, anticonvulsants, proton pump inhibitors).…”