Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.
Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study / Zarbock, A.; Weiss, R.; Albert, F.; Rutledge, K.; Kellum, J. A.; Bellomo, R.; Grigoryev, E.; Candela-toha, A. M.; Demir, Z. A.; Legros, V.; Rosenberger, P.; Menendez, P. G.; Alvarez, M. G.; Peng, K.; Leger, M.; Khalel, W.; Orhan-sungur, M.; Meersch, M.; Makhloufi, H.; Sakhraoui, R.; Ouyahia, A.; Rais, M.; Kouicem, A. T.; Derwish, K.; Abdoun, M.; Ouahab, I.; Bouaoud, S.; Tidjane, A.; Perez Rivera, C. J.; Garcia, J. P.; Ji, F. -H.; Ma, Z. -M.; Sklienka, P.; Elbahnasawy, M. G.; Elsalhawy, S.; Nafea, A. M.; Osman, N. A.; Emara, M. M.; Bonna, M. M.; Abdehaleem, I. A.; Abbas, A. M.; Abbas, M. S.; Esmaeil, H. M.; Joannes-Boyau, O.; Floch, T.; Muccio, S.; Menage-Innocenti, L.; Brochet, B.; Leclercq-Rouget, M.; Geneve, C.; Mocarquer, B. V.; Aveline, C.; Vautier, P.; Nadaud, J.; Rimmele, T.; Cerro, V.; Suria, S.; Elmawieh, J.; El-Jawiche, R.; Cirenei, C.; Lebuffe, G.; Ponsonnard, S.; Egreteau, P. -Y.; Ichai, C.; Jean-Michel, V.; Lasocki, S.; Masson, C.; Rineau, E.; Cassisa, V.; Verrier, P.; Atchade, E.; Rochon, C. -E.; Quentin, V.; Queixalos, N.; Braun, T.; Grand, H.; Mayeur, N.; Pasquie, M.; Garcon, P.; Bruckert, V.; Pradel, G.; Ramorasata, A.; Ravry, C.; Mottard, N.; Groote, T. V.; Dorr, C.; Kullmar, M.; Massoth, C.; Motekallemi, A.; Saadat-Gilani, K.; Kerschke, L.; Storck, M.; Varghese, J.; Wempe, C.; Grusser, L.; Kowark, A.; Brandenburger, T.; Hohn, A.; Haberle, H.; Hofmann, P.; Kuhle, J.; Calov, S.; Bernard, A. M.; Mirakaj, V.; Weber, K.; Pfister, K.; Stetz, L.; Muller, S. D.; Klaus, S.; Sadlo, M.; Sengelhoff, C.; Stenger, C. -K.; Gobel, U.; Heringlake, M.; Arnaoutoglou, E.; Stratigopoulou, P.; Danai, P.; Dimakopoulou, A.; Menis, A. -A.; Ioannidis, O.; Jalaawiy, H.; Anwar, A.; Hashim, H. T.; Rasheed Aldawoody, H. I.; Cortegiani, A.; Ippolito, M.; Marino, C.; Presti, G.; Fricano, D. C.; De Rosa, Silvia; Bianchin, Andrea; Paternoster, Gianluca; Fasciano, U.; Cutuli, S. L.; Spadaro, S.; Bussolati, E.; Palmieri, M.; Volta, C. A.; Tripodi, V. F.; Fiume, D.; Iuorio, A.; Santorsola, C.; Abu-Hussein, B.; Hasanein, K.; Shin, S.; Baek, J.; Kim, S.; Elhadi, M.; Aldressi, W.; Abuzeid, I. A.; Albaraesi, M. N.; Moftah, M. A.; Aldressi, S.; Abdulwahed, E.; Ali Alshareea, E. A.; Ashur Abujrad, A. A.; Ghmagh, R.; Biala, M. I.; Islam Benjouira, R. A.; Aliwa, M.; Msherghi, A.; Tuwaib, A.; Mustafa, T.; Zriba, H.; Agilla, H. M.; Sadek Ben Hamida, B. T.; Mohamed Otman, R. H.; Mijovska, M. M.; Camilleri Podesta, A. M.; Gasca Lopez, G. A.; Amro, S.; de Freitas Regufe, R.; Ivkin, A.; Balakhnin, D.; Shukevich, D.; Yaroustovsky, M.; Barmou, A.; Kaserer, A.; Castellucci, C.; Akbas, S.; Petrun, A. M.; Gregorcic, I.; Sok, V.; Links, A.; Barreto, E. B.; Melchor, J. R.; Becerra-Bolanos, A.; Rodriguez-Perez, A.; Estevez, J. M.; Matas, J. M.; Palao, S. P.; Alvarez, M. G.; Albadalejo, A. B.; Gonzalez, A. B.; Caro, A. M. G.; Blanco, I. H.; Fernandez, D. T.; Perez, G. H.; Ejea, M. L.; de la Rosa Ruiz, N.; Abasolo, M. G.; Ferreira, L.; Lobato, F.; Sevilla, M. A.; Erazo, A.; Paulis, B. C.; de la Calle Gil, I.; Adamove, P.; Blasco Blasco, F. M.; Garcia-Sanchez, J. I.; Zamorano, S. G.; Herreros, N. G.; Callejas, R.; Gomez, M. E.; Candela-Toha, A. M.; Claros-Llamas, E.; Cobeta-Orduna, P.; Crespo-Aliseda, P.; Dorado-Diaz, T.; Gomez-Rojo, M.; Mane-Ruiz, M. N.; Martin-Gonzalez, M. C.; Martinez-Perez, A.; Tiscar, C.; Calvo, V. E.; Espi, L. L.; Loaiza Aldean, Y. S.; Ariza, V. M.; Vila, L. V.; Garcia-Miguel, F. J.; Suliman, E. S. M.; Ibrahim, A. M.; Fadlalmola, H. A.; Swed, S.; Wu, V. -C.; Orhan-Sungur, M.; Altun, D.; Canbolat, N.; Dincer, M. B.; Yildirim, S. A.; Iyigun, M.; Yapici, D.; Ozdemir, L.; Sagun, A.; Boztug, N.; Gunduz, E.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 49:12(2023), pp. 1441-1455. [10.1007/s00134-023-07169-7]
Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
De Rosa Silvia;Palmieri M.;
2023-01-01
Abstract
Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.| File | Dimensione | Formato | |
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