Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Prowle, John R.; Forni, Lui G.; Bell, Max; Chew, Michelle; Edwards, Mark; Grams, Morgan E.; Grocott, Michael P.W.; Liu, Kathleen D.; McIlroy, David R.; Murray, Patrick; Ostermann, Marlies; Zarbock, Alexander; Bagshaw, Sean M.; Bartz, Raquel R.; Bell, Samira; Bïhorac, Azra; Gan, Tong J.; Hobson, Charles; Joannidis, Michael; Koyner, Jay L.; Levett, Denny; Mehta, Ravindra L.; Miller, Timothy E.; Mythen, Michael G.; Nadim, Mitra K.; Pearse, Rupert M; Rimmelé, Thomas; Ronco, Claudio; Shaw, Andrew; Kellum, John A.

doi:10.1038/s41581-021-00418-2

Cited by 130 publications

(134 citation statements)

References 132 publications

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“…Therefore, preoperative use of inotropes and diuretics was of great importance in this group of patients. The time and doses of diuretics should be carefully planned to reduce preload as much as possible, while not too quick to repeatedly induce transient intravascular depletion (26).…”

Section: Discussionmentioning

confidence: 99%

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesAcute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model.MethodsWe selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis.ResultsAmong two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, P < 0.001); had higher body mass index (difference 1.68 kg·m−2, P = 0.002); rates of smoking (OR = 2, P = 0.020), hypertension (OR = 2.83, P = 0.004), and renal dysfunction (OR = 3.58, P = 0.002); higher central venous pressure (difference 3 cm H2O, P < 0.001); and lower cardiac index (difference −0.23 L·min−1·m−2, P < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, P = 0.003), high body mass index (OR 1.10, P = 0.024), preoperative atrial arrhythmia (OR 3.12, P = 0.041), renal dysfunction (OR 2.70 P = 0.043), high central venous pressure (OR 1.12, P = 0.002), and low cardiac index (OR 0.36, P = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test P = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, P < 0.001).ConclusionThe prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.

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Section: Discussionmentioning

confidence: 99%

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…Our patient presented with significant heart failure for an urgent procedure. His cardiovascular condition is a known risk factor for postoperative AKI and pulmonary edema [ 1 , 12 , 13 ]. Fluid shifts, pain, and the overall stress response of surgery are additional contributory factors, which can further predispose one to postoperative AKI and pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

“…Fluid overload may lead to pulmonary edema and acute kidney injury (AKI) during the perioperative course in these patients. Similarly, excessive diuresis can result in hypoperfusion and also contribute to AKI [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery

Singh¹,

Carvalho²

2021

Cureus

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Venous excess ultrasound score (VExUS) is a recently described ultrasound-based scoring system that quantifies systemic congestion using Doppler flow indices of the hepatic and portal vein in addition to inferior vena cava assessment. There are many potential and emerging applications of this modality. We discuss the case of a severely congested heart failure patient presenting for urgent non-cardiac surgery where VExUS parameters were used to monitor and guide his decongestive therapy postoperatively.

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“…The CKD global incidence is increasing, with a global prevalence of 13.4%, and the number of ESRD people ranges from 4.902 to 7.083 million (43). The CKD etiologies include AKI, hypertension, toxic insults, diabetes mellitus, age, obesity, and nephrectomy (6,44). Besides, CKD has a wide range of characteristics and mechanisms, some of which are associated with AKI pathologic mechanisms.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Regeneration and Diagnosis of Kidney Disease Using Exosomes

Momen

Abdolmaleki

Asadi

et al. 2021

Jentashapir J Cell Mol Biol

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: A growing global prevalence of acute kidney injury (AKI) and chronic kidney disease (CKD), high costs of kidney transplantation, a shortage of kidney donors, and low survival rate after dialysis have popularized mesenchymal stem cell (MSC) therapy via transplantation. However, the risks of tumorigenesis, immune rejection, pathogen transmission, loss of differentiation, and morphological changes after long-term culture have prompted researchers to develop a safer and more effective therapy method. Therefore, cell-free approaches have been developed to reduce the risks associated with stem cell-based therapies. In cell-free therapy of AKI and CKD, MSC-derived extracellular vesicles, with nanometer sizes, are used, called exosomes. Exosomes have a lipid bilayer membrane with various genes, microRNAs, and proteins for kidney repair. As known, MSC-derived exosomes have improved the kidney regeneration process for various reasons, such as increased safety and reduced inflammation, immune rejection, and tumorigenesis. With the advancement of exosome isolation techniques, the possibility of using biologically active molecules for renal injury prediction and diagnosis has emerged. The use of urinary exosomes in AKI and CKD diagnosis is based on changes in the expression of specific molecule cargos of exosomes. This review article summarizes the diagnosis and therapeutic applications of exosomes in AKI and CKD.

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Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Cited by 130 publications

References 132 publications

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery

Regeneration and Diagnosis of Kidney Disease Using Exosomes

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