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Title: Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial.
Austin Authors: Meersch, Melanie;Weiss, Raphael;Strauß, Christian;Albert, Felix;Booke, Hendrik;Forni, Lui;Pittet, Jean-Francois;Kellum, John A;Rosner, Mitchell;Mehta, Ravindra;Bellomo, Rinaldo ;Rosenberger, Peter;Zarbock, Alexander
Affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
School of Medicine, University of Surrey, Kate Granger Building, Guildford, UK.;Intensive Care Unit, Royal Surrey Hospital, Guildford, UK.
Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA.
Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Medicine, University of California San Diego, San Diego, CA, USA.
Department of Critical Care, The University of Melbourne, Melbourne, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia.;Department of Intensive Care, Austin Health, Heidelberg, Australia.;Australian and New Zealand Intensive Care Research Centre, School orsity, Melbourne, Australia.f Public Health and Preventive Medicine, Monash Unive
Department of Anesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany.
Intensive Care
Issue Date: 29-Jan-2024
Date: 2024
Publication information: Intensive Care Medicine 2024-01-29
Abstract: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors.
DOI: 10.1007/s00134-023-07314-2
ORCID: 0000-0002-2124-1714
Journal: Intensive Care Medicine
PubMed URL: 38285051
ISSN: 1432-1238
Type: Journal Article
Subjects: Acute kidney disease
Acute kidney injury
Chronic kidney disease
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