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dc.contributor.authorMeersch, Melanie-
dc.contributor.authorWeiss, Raphael-
dc.contributor.authorStrauß, Christian-
dc.contributor.authorAlbert, Felix-
dc.contributor.authorBooke, Hendrik-
dc.contributor.authorForni, Lui-
dc.contributor.authorPittet, Jean-Francois-
dc.contributor.authorKellum, John A-
dc.contributor.authorRosner, Mitchell-
dc.contributor.authorMehta, Ravindra-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorRosenberger, Peter-
dc.contributor.authorZarbock, Alexander-
dc.identifier.citationIntensive Care Medicine 2024-01-29en_US
dc.description.abstractAcute 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.en_US
dc.subjectAcute kidney diseaseen_US
dc.subjectAcute kidney injuryen_US
dc.subjectChronic kidney diseaseen_US
dc.titleAcute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleIntensive Care Medicineen_US
dc.identifier.affiliationDepartment of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.en_US
dc.identifier.affiliationInstitute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.en_US
dc.identifier.affiliationDepartment of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.en_US
dc.identifier.affiliationSchool of Medicine, University of Surrey, Kate Granger Building, Guildford, UK.;Intensive Care Unit, Royal Surrey Hospital, Guildford, UK.en_US
dc.identifier.affiliationDepartment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA.en_US
dc.identifier.affiliationCenter for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.en_US
dc.identifier.affiliationDepartment of Medicine, University of Virginia, Charlottesville, VA, USA.en_US
dc.identifier.affiliationDepartment of Medicine, University of California San Diego, San Diego, CA, USA.en_US
dc.identifier.affiliationDepartment 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 Univeen_US
dc.identifier.affiliationDepartment of Anesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany.en_US
dc.identifier.affiliationIntensive Careen_US
item.fulltextNo Fulltext-
item.openairetypeJournal Article-
item.cerifentitytypePublications- Care- Analytics Research and Evaluation (DARE) Centre-
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