Management of post-operative acute kidney injury

Bell, Samira; Ross, Victoria C; Zealley, K.; Millar, F. A.; Isles, Chris

doi:10.1093/qjmed/hcw175

Cited by 18 publications

(23 citation statements)

References 47 publications

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“…Acute kidney injury (AKI) is a disease of complex etiology, not fully understood, that often takes place in the postoperative period of cardiovascular surgery [ 1 ] . The incidence of postoperative AKI in cardiovascular surgery remains high, approximately 20% of such surgical patients are affected [ 2 , 3 ] .…”

Section: Introductionmentioning

confidence: 99%

“…Among those undergoing cardiovascular surgery, 1% to 5% may require renal replacement therapy [ 4 ] . Clinical variables influence the occurrence of postoperative AKI, among other complications, and decreased survival rates [ 1 , 5 , 6 ] . Long-term survival among patients who underwent cardiovascular surgery and acquired postoperative AKI requiring dialysis should be evaluated in a diversified context, since it may confirm information regarding length of survival and its associated risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Silva

Cavalcante

Taniguchi

2018

Braz J Cardiovasc Surg

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ObjectiveAcute kidney injury (AKI) is a frequent postoperative complication after cardiovascular surgery. It has been described as a predictor of decreased survival rates, but how dialysis decreases survival when initiated on the postoperative period has yet to be determined. To analyze the survival of patients who presented postoperative AKI requiring dialysis up to 30 days after cardiovascular surgery and its risk factors is the aim of this study. MethodsOf the 5,189 cardiovascular surgeries performed in a 4-year period, 157 patients developed AKI requiring dialysis in the postoperative period. The Kaplan-Meier survival curve and log-rank test were used in the statistical analysis to compare the curves of categorical variables. P-value< 0.05 was considered significant.ResultsPatient average survival was 546 days and mortality was 70.7%. The need for dialysis on the postoperative period decreased late survival. Risk factors for decreased survival included age (P<0.001) and postoperative complications (P<0.0003).ConclusionThe average survival was approximately one year among dialytic patients. Age and postoperative complications were risk factors that determined decreased survival.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Silva

Cavalcante

Taniguchi

2018

Braz J Cardiovasc Surg

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“…12 28 Its pathogenesis may include inflammation, hypotension and perioperative nephrotoxin usage. [29][30][31] Aggravation of the systemic inflammatory response is an important contributor to the development of AKI. 32 CRP may also act as a pathogenic mediator in the development of AKI.…”

Section: Discussionmentioning

confidence: 99%

Predictive role of vitamin B₁₂ in acute kidney injury in living donor liver transplantation: a propensity score matching analysis

Park

Choi

et al. 2020

BMJ Open

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ObjectivesWe examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT).DesignRetrospective observational cohort study.SettingUniversity hospital, from January 2009 to December 2018.ParticipantsA total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded.Primary and secondary outcome measuresThe population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated.ResultsPreoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900 pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level.ConclusionsOur study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.

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“…Physiological oliguria may result, for example, from antidiuresis due to hypovolemia, after significant food and water fasting and also after ultra-endurance events, where oliguria is experienced by some athletes during and up to some hours after the event [ 18 ], however, these episodes of oliguria seem to be fully reversible, and do not increase the risk for subsequent kidney injury [ 19 ]. Transitory oliguria is also frequently observed in post-operative non-critically ill patients associated with vasopressin-release and activation from the sympathetic nervous system from pain or nausea [ 20 ].…”

Section: Pathophysiologymentioning

confidence: 99%

Oliguria in critically ill patients: a narrative review

et al. 2018

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Oliguria is often observed in critically ill patients. However, different thresholds in urine output (UO) have raised discussion as to the clinical importance of a transiently reduced UO of less than 0.5 ml/kg/h lasting for at least 6 h. While some studies have demonstrated that isolated oliguria without a concomitant increase in serum creatinine is associated with higher mortality rates, different underlying pathophysiological mechanisms suggest varied clinical importance of reduced UO, as some episodes of oliguria may be fully reversible. We aim to explore the clinical relevance of oliguria in critically ill patients and propose a clinical pathway for the diagnostic and therapeutic management of an oliguric, critically ill patient.

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Management of post-operative acute kidney injury

Abstract: Conflict of InterestsThe authors declare no conflict of interests. AbstractPost-operative Acute Kidney Injury (AKI) is a common complication of surgery with

Cited by 18 publications

References 47 publications

Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Predictive role of vitamin B₁₂ in acute kidney injury in living donor liver transplantation: a propensity score matching analysis

Oliguria in critically ill patients: a narrative review

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Management of post-operative acute kidney injury

Abstract: Conflict of InterestsThe authors declare no conflict of interests. AbstractPost-operative Acute Kidney Injury (AKI) is a common complication of surgery with

Cited by 18 publications

References 47 publications

Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery

Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis

Oliguria in critically ill patients: a narrative review

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Product

Resources

About

Predictive role of vitamin B₁₂ in acute kidney injury in living donor liver transplantation: a propensity score matching analysis