Pre-operative proteinuria and post-operative acute kidney injury in noncardiac surgery: the NARA-Acute Kidney Injury cohort study

Nishimoto, Masatoshi; Murashima, Miho; Kokubu, Maiko; Matsui, Masaru; Eriguchi, Masahiro; Samejima, Ken-ichi; Akai, Yasuhiro; Tsuruya, Kazuhiko

doi:10.1093/ndt/gfz269

Cited by 11 publications

(15 citation statements)

References 28 publications

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“…It has been associated with worsening fluid overload through increases in sodium and water retention and cardiac filling pressures, ultimately exacerbating heart failure (12). Furthermore, albuminuria serves as an excellent risk marker for the development of AKI, with higher values indicating greater risk and renal susceptibility (13).…”

Section: Biomarkers For Diagnosis Aki During Cardiac Failurementioning

confidence: 99%

Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury

Granado¹,

Chávez-Íñiguez²

2023

Preprint

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Biomarkers have become an important tool in the diagnosis and management of cardio renal syndromes (CRS), a complex condition characterized by dysfunction in both the cardiovascular and renal systems. These biomarkers can help identify the presence and severity of CRS, predict its progression and outcomes, and facilitate personalized treatment options. Several biomarkers, including natriuretic peptides, troponins, and inflammatory markers, have been extensively studied in CRS and have shown promising results in improving diagnosis and prognosis. In addition, emerging biomarkers such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin offer potential for early detection and intervention of CRS. However, the use of biomarkers in CRS is still in its infancy, and further research is needed to establish their utility in routine clinical practice. This review highlights the role of biomarkers in the diagnosis, prognosis, and management of CRS and discusses their potential as valuable clinical tools for personalized medicine in the future.

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Section: Biomarkers For Diagnosis Aki During Cardiac Failurementioning

confidence: 99%

Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury

Granado¹,

Chávez-Íñiguez²

2023

Preprint

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“…The following are excluded: 10 duplicate records, 8 conference abstracts, 8 case reports, 6 notes, letters, or editorials, 18 reviews, 1 non-surgical record, 9 non-preoperative proteinuria records, 25 non-postoperative AKI records, 20 unrelated records, 1 record with children as participants, 3 nephrectomy records, and 4 records are excluded for other reasons. Therefore, we identify 10 records including 11 studies totally and report studies for our meta-analysis [14][15][16][17][18][19][20][21][22][23][24] (Figure 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Preoperative proteinuria may be a risk factor for postoperative acute kidney injury：a meta-analysis

Huang

2021

Renal Failure

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Objective: To investigate the relationship between preoperative proteinuria and postoperative acute kidney injury (AKI). Methods: We performed a search on databases included PubMed, Embase, the Cochrane Library, and Web of Science, from December 2009 to September 2020. Data extracted from eligible studies were synthesized to calculate the odds ratio (OR) and 95% confidence interval (CI). A fixed or random effects model was applied to calculate the pooled OR based on heterogeneity through the included studies. Results: This meta-analysis of 11 observational studies included 203,987 participants, of whom 21,621 patients suffered from postoperative AKI and 182,366 patients did not suffer from postoperative AKI. The combined results demonstrated that preoperative proteinuria is an independent risk factor for postoperative AKI (adjusted OR ¼ 1.65, 95%CI:1.44-1.89, p < 0.001). Subgroup analysis showed that both preoperative mild proteinuria (adjusted OR ¼ 1.30, 95%CI:1.24-1.36, p < 0.001) and preoperative heavy proteinuria (adjusted OR ¼ 1.93, 95%CI:1.65-2.27, p < 0.001) were independent risk factors for postoperative AKI. The heterogeneity was combined because its values were lower. Further subgroup analysis found that preoperative proteinuria measured using dipstick was an independent risk factor for postoperative AKI (adjusted OR ¼ 1.48, 95%CI:1.37-1.60, p < 0.001). Finally, preoperative proteinuria was an independent risk factor for postoperative AKI in the non-cardiac surgery group (adjusted OR ¼ 2.06, 95%CI:1.31-3.24, p ¼ 0.002) and cardiac surgery group (adjusted OR ¼ 1.69, 95%CI:1.39-2.06, p < 0.001) Conclusion: Preoperative proteinuria is an independent risk factor for postoperative AKI and in instances when proteinuria is detected using dipsticks.

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“…The aim of the present study was to validate the SPARK index for PO-AKI in the NARA-AKI cohort, a retrospective cohort of AKI following noncardiac surgery in Japan. 9 , 10 , 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

“…Thus, further external validation in a different population is warranted. The aim of the present study was to validate the SPARK index for PO-AKI in the NARA-AKI cohort, a retrospective cohort of AKI following noncardiac surgery in Japan …”

Section: Introductionmentioning

confidence: 99%

External Validation of a Prediction Model for Acute Kidney Injury Following Noncardiac Surgery

Nishimoto

Murashima

Kokubu³

et al. 2021

JAMA Netw Open

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IMPORTANCEThe Simple Postoperative AKI Risk (SPARK) index is a prediction model for postoperative acute kidney injury (PO-AKI) in patients undergoing noncardiac surgery. External validation has not been performed. OBJECTIVE To externally validate the SPARK index. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective cohort study included adults who underwent noncardiac surgery under general anesthesia from 2007 to 2011. Those with obstetric or urological surgery, estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73 m 2 , preoperative dialysis, or an expected surgical duration of less than 1 hour were excluded. The study was conducted at Nara Medical University Hospital. Data analysis was conducted from January to July 2021. EXPOSURES Risk factors for AKI included in SPARK index. MAIN OUTCOMES AND MEASURES PO-AKI, defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours or 150% compared with preoperative baseline value or urine output of less than 0.5 mL/kg/h for at least 6 hours within 1 week after surgery, and critical AKI, defined as either AKI stage 2 or greater and/or any AKI connected to postoperative death or requiring kidney replacement therapy before discharge. The discrimination and calibration of the SPARK index were examined with area under the receiver operating characteristic curves (AUC) and calibration plots, respectively. RESULTS Among 5135 participants (2410 [46.9%] men), 303 (5.9%) developed PO-AKI, and 137 (2.7%) developed critical AKI. Compared with the SPARK cohort, participants in our cohort were older (median [IQR] age, 56 [44-66] years vs 63 [50-73] years), had lower baseline eGFR (median [IQR], 82.1 [71.4-95.1] mL/min/1.73 m 2 vs 78.2 [65.6-92.2] mL/min/1.73 m 2 ), and had a higher prevalence of comorbidities (eg, diabetes: 3956 of 51 041 [7.8%] vs 802 [15.6%]). The incidence of PO-AKI and critical AKI increased as the scores on the SPARK index increased. For example, 10 of 593 participants (1.7%) in SPARK class A, indicating lowest risk, experienced PO-AKI, while 53 of 332 (16.0%) in SPARK class D, indicating highest risk, experienced PO-AKI. However, AUCs for PO-AKI and critical AKI were 0.67 (95% CI, 0.63-0.70) and 0.62 (95% CI, 0.57-0.67), respectively, and the calibration was poor (PO-AKI: y = 0.24x + 3.28; R 2 = 0.86; critical AKI: y = 0.20x + 2.08; R 2 = 0.51).Older age, diabetes, expected surgical duration, emergency surgery, renin-angiotensin-aldosterone system blockade use, and hyponatremia were not associated with PO-AKI in our cohort, resulting in overestimation of the predicted probability of AKI in our cohort.

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Pre-operative proteinuria and post-operative acute kidney injury in noncardiac surgery: the NARA-Acute Kidney Injury cohort study

Cited by 11 publications

References 28 publications

Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury

Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury

Preoperative proteinuria may be a risk factor for postoperative acute kidney injury：a meta-analysis

External Validation of a Prediction Model for Acute Kidney Injury Following Noncardiac Surgery

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