Pre-operative proteinuria, postoperative acute kidney injury and mortality

Abstract

OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. CONCLUSION Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. PROSPERO REGISTRATION CRD42020190065.

Development of a Machine Learning Model of Postoperative Acute Kidney Injury Using Non-Invasive Time-Sensitive Intraoperative Predictors

“…Acute kidney injury (AKI) is a major postoperative complication associated with a higher risk of death, chronic kidney injury, long-term major adverse cardiovascular events, and cost of care [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Implementing reno-protective strategies has been shown to prevent episodes of AKI in high-risk patients identified by biomarkers [ 11 ]; however, lab tests for biomarkers are expensive and not widely available or used.…”

Perioperative acute kidney injury: impact and recent update

“…Risks factors for postoperative AKI include hemodynamic derangements, medications, infectious, inflammatory, and immune factors, cardiac surgery, advanced age, comorbidities (hypertension, diabetes), and a lower baseline estimated GFR (eGFR) [14]. Anesthesiologists should be aware that some disease specific AKI risk factors may exist for certain conditions like hip and knee surgery [8,15] and other non-urology surgery [16]. Postoperative AKI has been shown to progress to chronic kidney disease [17,18] with economic consequences.…”