Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Abstract

Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.

Development of interpretable machine learning models for prediction of acute kidney injury after noncardiac surgery: a retrospective cohort study

“…Our study found that the length and type of surgery, as well as intraoperative hemodynamics, vasopressors use, and blood transfusions were important predictors of postoperative AKI. In line with previous research 53 , we found that different types of surgery are associated with different incidence of postoperative AKI. Although the type of surgery is not modifiable, shortening the surgery time may reduce the risk of AKI for patients, especially high-risk patients 26 .…”

“…We also found that use of vasopressors was associated with increased risk of AKI. This can be explained that use of vasopressors represents a surrogate marker for less stable hemodynamics 53 . Moreover, there are also data showing that higher vasopressor use affects renal function due to decreased renal perfusion 54 .…”

Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study

“…In addition, the negative effects of FA on short and mid-term renal outcome are mainly present in patients with severe acute kidney injury (AKI 3) and were without relation to prior CKD status in our analysis. This goes in line with the recently published multicenter, observational EPIS-AKI study: patients developing a postsurgical AKI received intra- and postoperatively significantly more fluids compared to patients without AKI [ 41 ]. In addition, a postsurgical AKI was strongly associated with MAKE90, with the highest incidence in patients with AKI stage 3 [ 41 ].…”

Acute kidney injury after cardiac surgery

“…The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) may be as high as 50%, depending on the setting, patient cohort, and type of cardiac surgery [1,2]. Importantly, survival rates decrease with more severe AKI stages and even after complete recovery of CS-AKI, patients remain at an increased risk of persisting renal dysfunction or death [3].…”