IRIS

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: 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. Results: 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%. Conclusion: 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.

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial / Meersch, ; ; Weiss, M.; ; Strauss, R.; ; Albert, C.; ; Booke, F.; ; Forni, H.; ; Pittet, L.; ; Kellum, J.; ; Rosner, J. A.; ; Mehta, M.; ; Bellomo, R.; ; Rosenberger, R.; ; Zarbock, P.; ; Makhloufi, A.; ; Sakhraoui, H.; ; Ouyahia, R.; ; Rais, A.; ; Kouicem, M.; ; Derwish, A. T.; ; Abdoun, K.; ; Ouahab, M.; ; Bouaoud, I.; ; Tidjane, S.; ; Perez Rivera, A.; ; Garcia, C. J.; ; Peng, J. P.; ; Ma, K. ; Ji F. -H.; ; Elbahnasawy, Z. -M.; ; Elsalhawy, M. G.; ; Nafea, S.; ; Osman, A. M.; ; Emara, N. A.; ; Bonna, M. M.; ; Abdehaleem, M. M.; ; Abbas, I. A.; ; Abbas, A. M.; ; Esmaeil, M. S.; ; Joannes-Boyau, H. M.; ; Legros, O.; ; Floch, V.; ; Muccio, T.; ; Menage-Innocenti, S.; ; Brochet, L.; ; Leclercq-Rouget, B.; ; Avelinem, M. ; Genevem C. ; Mocarquerm B. V.; ; Vautierm, C.; ; Nadaudm, P.; ; Rimmelem, J.; ; Cerrom, T.; ; Suriam, V.; ; Elmawiehm, S.; ; El-Jawiche, J.; ; Cirenei, R.; ; Lebuffe, C.; ; Ponsonnard, G.; ; Egreteau, S.; ; Ichai, P. -Y.; ; Jean-Michel, C.; ; Leger, V.; ; Lasocki, M.; ; Masson, S.; ; Rineau, C.; ; Cassisa, E.; ; Verrier, V.; ; Atchade, P.; ; Rochon, E.; ; Quentin, C. -E.; ; Queixalos, V.; ; Braun, N.; ; Grand, T.; ; Mayeur, H.; ; Pasquie, N.; ; Garcon, M.; ; Bruckert, P.; ; Pradel, V.; ; Ramorasata, G.; ; Ravry, A.; ; Mottard, C.; ; von Groote, N.; ; Dorr, T.; ; Kullmar, C.; ; Massoth, M.; ; Motekallemi, C.; ; Saadat-Gilani, A.; ; Kerschke, K.; ; Storck, L.; ; Varghese, M.; ; Wempe, J.; ; Grusser, C.; ; Kowark, L.; ; Brandenburger, A.; ; Hohn, T.; ; 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 A. ; Paternoster Gianluca; Fasciano U. ; Cutuli S. L. ; Savino S. ; Enrico B. ; Marco P. ; Alberto V. C. ; 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. ; Khalel W. ; Abdulwahed E. ; Ali Alshareea E. A. ; Abujrad Reem Ghmagh A. A. A. ; Biala M. I. ; Benjouira R. A. I. ; 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. ; Podesta A. M. C. ; Gasca Lopez G. A. ; Amro S. ; de Freitas Regufe R. ; Grigoryev E. ; 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 F. M. B. ; 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. ; Gonzalez M. C. M. ; Martinez-Perez A. ; Tiscar C. ; Menendez P. G. ; Calvo V. E. ; Espi L. L. ; Aldean Y. S. L. ; 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. ; Lafli-Tunay D. ; Karakaya D. ; Dost B. ; Komurcu O. ; Dilmen O. K. ; Akcil E. F. ; Tunali Y. ; Ok G. ; Tok-Alsina E. ; Polat C. ; Kizilcik N. ; Sen O. ; Darcin K. ; Ugur S. ; Gurkan Y. ; Saracoglu K. T. ; Yildiz-Koyuncu O. ; Demir Z. A. ; Postaci N. A. ; Ozgok A. ; Karadeniz U. ; Ozay H. Y. ; Balci E. ; Salman N. ; Girgin B. ; Sagir O. ; Demir H. F. ; Ugun F. ; Toprak H. I. ; Ozcan M. S. ; Alkaya-Solmaz F. ; Yilmaz M. ; Karaca U. ; Sahin S. H. ; Erkoc S. K. ; Alkis N. ; Baytas V. ; Erturk E. ; Saylan S. ; Akdogan A. ; Yesil B. B. ; Boran O. F. ; Orak Y. ; Calisir F. ; Buyukcoban S. ; Kuvaki B. ; Cansabuncu S. ; Akesen S. ; Goren S. ; Yeniocak T. ; Orman O. ; Karka O. E. ; Sahin T. ; Momot N. ; Panchenko A. ; Pittet J. -F. ; Rutledge K., A.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 50:2(2024), pp. 247-257. [10.1007/s00134-023-07314-2]

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

A. M. ; Osman;
2024-01-01

Abstract

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: 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. Results: 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%. Conclusion: 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.
2024
INTENSIVE CARE MEDICINE
2
38285051
2-s2.0-85183393467
WOS:001156830700001
Meersch, ; ; Weiss, M.; ; Strauss, R.; ; Albert, C.; ; Booke, F.; ; Forni, H.; ; Pittet, L.; ; Kellum, J.; ; Rosner, J. A.; ; Mehta, M.; ; Bellomo, R....espandi
Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial / Meersch, ; ; Weiss, M.; ; Strauss, R.; ; Albert, C.; ; Booke, F.; ; Forni, H.; ; Pittet, L.; ; Kellum, J.; ; Rosner, J. A.; ; Mehta, M.; ; Bellomo, R.; ; Rosenberger, R.; ; Zarbock, P.; ; Makhloufi, A.; ; Sakhraoui, H.; ; Ouyahia, R.; ; Rais, A.; ; Kouicem, M.; ; Derwish, A. T.; ; Abdoun, K.; ; Ouahab, M.; ; Bouaoud, I.; ; Tidjane, S.; ; Perez Rivera, A.; ; Garcia, C. J.; ; Peng, J. P.; ; Ma, K. ; Ji F. -H.; ; Elbahnasawy, Z. -M.; ; Elsalhawy, M. G.; ; Nafea, S.; ; Osman, A. M.; ; Emara, N. A.; ; Bonna, M. M.; ; Abdehaleem, M. M.; ; Abbas, I. A.; ; Abbas, A. M.; ; Esmaeil, M. S.; ; Joannes-Boyau, H. M.; ; Legros, O.; ; Floch, V.; ; Muccio, T.; ; Menage-Innocenti, S.; ; Brochet, L.; ; Leclercq-Rouget, B.; ; Avelinem, M. ; Genevem C. ; Mocarquerm B. V.; ; Vautierm, C.; ; Nadaudm, P.; ; Rimmelem, J.; ; Cerrom, T.; ; Suriam, V.; ; Elmawiehm, S.; ; El-Jawiche, J.; ; Cirenei, R.; ; Lebuffe, C.; ; Ponsonnard, G.; ; Egreteau, S.; ; Ichai, P. -Y.; ; Jean-Michel, C.; ; Leger, V.; ; Lasocki, M.; ; Masson, S.; ; Rineau, C.; ; Cassisa, E.; ; Verrier, V.; ; Atchade, P.; ; Rochon, E.; ; Quentin, C. -E.; ; Queixalos, V.; ; Braun, N.; ; Grand, T.; ; Mayeur, H.; ; Pasquie, N.; ; Garcon, M.; ; Bruckert, P.; ; Pradel, V.; ; Ramorasata, G.; ; Ravry, A.; ; Mottard, C.; ; von Groote, N.; ; Dorr, T.; ; Kullmar, C.; ; Massoth, M.; ; Motekallemi, C.; ; Saadat-Gilani, A.; ; Kerschke, K.; ; Storck, L.; ; Varghese, M.; ; Wempe, J.; ; Grusser, C.; ; Kowark, L.; ; Brandenburger, A.; ; Hohn, T.; ; 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 A. ; Paternoster Gianluca; Fasciano U. ; Cutuli S. L. ; Savino S. ; Enrico B. ; Marco P. ; Alberto V. C. ; 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. ; Khalel W. ; Abdulwahed E. ; Ali Alshareea E. A. ; Abujrad Reem Ghmagh A. A. A. ; Biala M. I. ; Benjouira R. A. I. ; 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. ; Podesta A. M. C. ; Gasca Lopez G. A. ; Amro S. ; de Freitas Regufe R. ; Grigoryev E. ; 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 F. M. B. ; 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. ; Gonzalez M. C. M. ; Martinez-Perez A. ; Tiscar C. ; Menendez P. G. ; Calvo V. E. ; Espi L. L. ; Aldean Y. S. L. ; 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. ; Lafli-Tunay D. ; Karakaya D. ; Dost B. ; Komurcu O. ; Dilmen O. K. ; Akcil E. F. ; Tunali Y. ; Ok G. ; Tok-Alsina E. ; Polat C. ; Kizilcik N. ; Sen O. ; Darcin K. ; Ugur S. ; Gurkan Y. ; Saracoglu K. T. ; Yildiz-Koyuncu O. ; Demir Z. A. ; Postaci N. A. ; Ozgok A. ; Karadeniz U. ; Ozay H. Y. ; Balci E. ; Salman N. ; Girgin B. ; Sagir O. ; Demir H. F. ; Ugun F. ; Toprak H. I. ; Ozcan M. S. ; Alkaya-Solmaz F. ; Yilmaz M. ; Karaca U. ; Sahin S. H. ; Erkoc S. K. ; Alkis N. ; Baytas V. ; Erturk E. ; Saylan S. ; Akdogan A. ; Yesil B. B. ; Boran O. F. ; Orak Y. ; Calisir F. ; Buyukcoban S. ; Kuvaki B. ; Cansabuncu S. ; Akesen S. ; Goren S. ; Yeniocak T. ; Orman O. ; Karka O. E. ; Sahin T. ; Momot N. ; Panchenko A. ; Pittet J. -F. ; Rutledge K., A.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 50:2(2024), pp. 247-257. [10.1007/s00134-023-07314-2]
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