Perioperative Acute Kidney Injury

Gumbert, Sam D.; Kork, Felix; Jackson, M; Vanga, Naveen; Ghebremichael, Semhar J.; Wang, Christy Y.; Eltzschig, Holger K.

doi:10.1097/aln.0000000000002968

Cited by 174 publications

(122 citation statements)

References 194 publications

(283 reference statements)

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“…Considering data from the literature, we assumed a renal complication rate of 15% in high-risk surgical patients [4,7,12]. Therefore, we estimated that at least 1,000 patients would be required to conduct the study with the inclusion of fteen explanatory variables in a robust logistic regression model, with 28-day mortality as the dependent variable.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

Katayama¹,

Gomes²,

Lobo³

et al. 2020

Preprint

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Background: Patients who develop postoperative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after noncardiac surgery and the possible risk factors for this complication. Methods: A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after noncardiac surgery was conducted to assess whether they developed AKI. The outcomes of patients who developed AKI were then compared to those of patients who did not develop it. Results: A total of 29 ICUs participated, of which 904 involved high-risk surgical patients who were included in the study. The occurrence of AKI in the postoperative period was 15.8%, and the mortality rate of postoperative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; P= 0.001), and higher length of ICU stay (P< 0.001), length of hospital stay (P<0.001) and length of mechanical ventilator stay (P<0.001). Independent factors for the risk of developing AKI were preoperative anemia (OR=7.0; P= 0.001), SAPS 3 ( OR= 1.04, P<0.001), postoperative vasopressor use (OR= 2.47; P<0.001), postoperative infection (OR= 8.8; P<0.001), need for reoperation (OR= 7.1; P<0.001) and elective surgery (OR= 0.4; P<0.001) was protective for AKI. In addition, patients with higher perioperative fluid balance had more chance for AKI.Conclusions: AKI is associated with risk of death. Patients with anemia prior to surgery, who had a higher SAPS 3, needed a postoperative vasopressor or had postoperative infection or needed reoperation were more likely to develop AKI, as were those with a higher perioperative fluid balance.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

Katayama¹,

Gomes²,

Lobo³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…A growing body of evidence suggests a disconnect between SCr and adverse outcomes in certain clinical circumstances. SCr can be in uenced by volume overload, nutrition, steroids, and muscle trauma; thus, relying solely on SCr for the diagnosis of AKI can be problematic, especially in critically ill patients [27]. In fact, low to moderate SCr levels are anticipated and tolerated and seem unrelated to signi cant renal injury We acknowledge that several limitations exist in this study.…”

Section: Discussionmentioning

confidence: 95%

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Jiang

Kong

2020

Preprint

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Objectives This study aimed to identify the incidence rate of Acute kidney injury (AKI) in our center, assess risk factors for one-year mortality, and predict short- and long-term survival after heart transplantation (HTx). Methods This single-center, retrospective study from October 2009 to Jan 2020 analyzed the pre-, intra-, and postoperative characteristics of 87 patients who underwent HTx. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk factors were analyzed by multivariable logistic regression models. The log-rank test was used to compare long-term survival. Results Twenty-six (36.1%) patients developed AKI. The one-year mortality rates in HTx patients with and without AKI were 26.92% and 10.87%, respectively (P > 0.05). Recipients who required renal replacement therapy (RRT) had a one-year mortality rate of 53.85% compared to 10.87% in those without AKI or RRT (P = 0.003). A long cardiopulmonary bypass (CPB) time (OR: 1.622, 95% CI: 1.014 to 2.595, P = 0.044) was positively related to the occurrence of AKI. A high intraoperative urine volume (OR: 0.566, 95% CI: 0.344 to 0.930, P = 0.025) was negatively correlated with AKI. AKI requiring RRT (HR, 6.402; 95% CI, 2.014–20.355, P = 0.002) was a risk factor for death. Overall survival in patients without AKI at 1, 3, and 5 years was higher than that in patients with AKI (P > 0.05). Conclusions AKI is common after HTx and adversely impacts early mortality. A long CPB time and low intraoperative urine volume maybe associated with the occurrence of AKI. AKI requiring RRT could contribute powerful prognostic information to predict short-term survival.

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“…Indeed, the kidney is one of the organs at particularly increased risk of injury during the perioperative period. Since the kidneys receive nearly 25% of cardiac output, they are continuously exposed to nephrotoxins during surgery (13,49); and hemodynamic alterations, including hypotension and hypovolemia, place the kidneys at additional risk for injury. Surgeries performed on the aorta, such as abdominal aortic repair, require clamping of the abdominal aorta and/or renal vessels, which directly induces ischemic injury.…”

Section: Discussionmentioning

confidence: 99%

Annexin A1 tripeptide mimetic increases sirtuin-3 to augment mitochondrial function and limit ischemic kidney injury

Suliman

Zhang

et al. 2020

Preprint

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BackgroundAcute kidney injury (AKI) is one of the most common organ failures following surgery. We have developed a tripeptide mimetic (ANXA1sp) of the parent annexin A1 molecule that shows promise as an organ protectant limiting cellular stress; however, its potential as a kidney protective agent remains unexplored, and its mechanism of action is poorly understood. Our hypothesis was that ANXA1sp would limit kidney injury and improve mitochondrial function following surgical ischemic kidney injury.MethodsIn blinded fashion, wildtype mice were assigned to receive vehicle control or experimental drug (ANXA1sp) 1 hour prior to and 1 hour after kidney vascular clamping. Our primary outcome was assessment of kidney injury and function by measurement of serum creatinine and blood urea nitrogen (BUN) and histologic injury scoring of kidney tissue sections. Immunofluorescence microscopy, real-time PCR and western blot were used to assess cell death, oxidative stress, and mitochondrial biomarkers. An in vitro model of oxygen-glucose deprivation in immortalized kidney tubule cells was used.ResultsANXA1sp given prior to and after ischemic kidney injury abrogated ischemic AKI. ANXA1sp further limited kidney cell death and oxidative stress following ischemia. ANXA1sp significantly improved markers associated with mitochondrial DNA repair and mitochondrial biogenesis. ANXA1sp upregulated expression of the mitochondrial protectant sirtuin-3 (SIRT3) in the mitochondria of kidney tubular cells. Silencing of SIRT3 limited ANXA1sp-mediated protection against hypoxic cell death.ConclusionsANXA1sp limits kidney injury through upregulation of SIRT3 and consequent preservation of mitochondrial function. ANXA1sp holds considerable promise as a perioperative kidney protectant prior to ischemia inducing surgery and/or kidney transplantation.

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Perioperative Acute Kidney Injury

Cited by 174 publications

References 194 publications

WITHDRAWN: Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

WITHDRAWN: Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Annexin A1 tripeptide mimetic increases sirtuin-3 to augment mitochondrial function and limit ischemic kidney injury

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