Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction

Turan, Alparslan; Cohen, Barak; Adegboye, Janet; Makarova, Natalya; Liu, Liu; Mascha, Edward J.; Qiu, Yuwei; Irefin, Samuel A.; Wakefield, Brett J.; Ruetzler, Kurt; Sessler, Daniel I.

doi:10.1097/aln.0000000000003109

Cited by 61 publications

(50 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results were similar to previous studies [8]. Severe AKI is associated with increased mortality [32]; furthermore, mild AKI also negatively affected long-term functional recovery after partial nephrectomy and may increase the proportion of CKD upstaging [33,34].…”

Section: Discussionsupporting

confidence: 91%

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

Kong

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management could reduce AKI in patients following partial nephrectomy. Methods: This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0 - 4.0 L/min/m2 and mean arterial pressure > 95mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results: From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72, control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28-1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups.Conclusion: For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results.Trial registration: Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.

show abstract

Section: Discussionsupporting

confidence: 91%

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

Kong

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Our results are in agreement with the only available study which examines the association of mild AKI with long-term renal injury [20]. This study, recently published by Turan et al, utilized a large database from the Cleveland Clinic that included more than 15,000 patients who underwent a variety of noncardiac surgical procedures ranging from low to high-risk.…”

Section: Discussionsupporting

confidence: 89%

“…Dichotomous variables are presented as crude numbers and percentages and were compared between groups using a Chi-square test. Modelling of the risk of longterm renal injury was performed using the same approach as Turan et al [20] including early AKI and all covariates listed in Tables 1 and 2 in a logistic (binomial) model. The risk of developing long-term renal injury is presented as an odds ratio with 95% con dence intervals.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, many clinicians (surgeons, intensivists and anaesthesiologists), routinely under-recognise the importance of mild AKI, [18] as they often consider postoperative AKI to be a transient phenomenon without short or long-term consequences [19]. However, Turan et al recently reported that mild postoperative AKI could affect long-term renal function in patients who had had various non-cardiac surgical procedures [20]. Nevertheless, there is limited speci c literature regarding the long-term renal consequences of mild AKI after major abdominal surgery [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…However, Turan et al recently reported that mild postoperative AKI could affect long-term renal function in patients who had had various non-cardiac surgical procedures [20]. Nevertheless, there is limited speci c literature regarding the long-term renal consequences of mild AKI after major abdominal surgery [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Acute kidney injury after colorectal surgery with prophylactic ureteral stents

Rather,

Fisher,

Gardner

et al. 2024

Surg Endosc

View full text Add to dashboard Cite

Background After colorectal surgery, acute kidney injury (AKI) results from a complex interplay of multiple independent causes and preventive measures that occur during the hospitalization. Prophylactic stenting for ureter identification has been identified as a potential cause, but the evidence is conflicting, possibly because of differing baseline characteristics and procedure-related approaches. Objective This retrospective cohort study assesses the role of stents in the etiology of AKI after determining the independent predictors of AKI. Methods From a population of 1224 consecutive colorectal patients (from 8/1/2016 through 12/31/2021), 382 (31.2%) received ureteral stents, and propensity score matching was used to create stented and control groups. Emergent cases and patients with sepsis were excluded from the analysis. Previously identified independent predictors of AKI, minimally invasive procedures, and a history of diabetes mellitus were used as criteria to create two balanced groups. Results Baseline demographic characteristics and procedure-related factors baseline factors were similar between the groups. There was no difference in the rate of AKI between stented patients and controls (P = 0.82), nor was there any difference in postoperative complications, such as chronic renal insufficiency (CRI, P = 0.49), average postoperative creatinine (P = 0.67), urinary tract infections (UTI, P = 0.82), any postoperative infection (P = 0.48), in-hospital complications (P = 1.00), length of stay (LOS, P = 0.15), and 30-day readmissions (P = 0.79). Conclusions In a population of patients where stenting was frequently employed, ureter stents placed for identification did not appear to cause AKI or AKI-related complications. Graphical Abstract

show abstract

Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction

Cited by 61 publications

References 24 publications

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

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

Acute kidney injury after colorectal surgery with prophylactic ureteral stents

Contact Info

Product

Resources

About