Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Por:
Zarbock, A, Weiss, R, Albert, F, Rutledge, K, Kellum, JA, Bellomo, R, Grigoryev, E, Candela-Toha, AM, Demir, ZA, Legros, V, Rosenberger, P, Menendez, PG, Alvarez, MG, Peng, K, Leger, M, Khalel, W, Orhan-Sungur, M, Meersch, M
Publicada:
28 jul 2023
Ahead of Print:
1 jul 2023
Resumen:
PurposeThe 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.MethodsWe 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.ResultsWe 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.ConclusionIn 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.
Filiaciones:
Zarbock, A:
Univ Hosp Munster, Dept Anesthesiol Intens Care & Pain Med, Albert Schweitzer Campus 1,Gebaude A1, D-48149 Munster, Germany
Outcome Res Consortium, Cleveland, OH 44195 USA
Weiss, R:
Univ Hosp Munster, Dept Anesthesiol Intens Care & Pain Med, Albert Schweitzer Campus 1,Gebaude A1, D-48149 Munster, Germany
Albert, F:
Univ Munster, Inst Biostat & Clin Res, Munster, Germany
Rutledge, K:
Univ Alabama Birmingham, Dept Anesthesiol & Perioperat Med, Birmingham, AL USA
Kellum, JA:
Univ Pittsburgh, Ctr Crit Care Nephrol, Dept Crit Care Med, Pittsburgh, PA USA
Bellomo, R:
Univ Melbourne, Dept Crit Care, Melbourne, Australia
Royal Melbourne Hosp, Dept Intens Care, Parkville, Vic, Australia
Austin Hlth, Dept Intens Care, Heidelberg, Australia
Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Publ Hlth & Prevent Med, Melbourne, Australia
Grigoryev, E:
Kemerovo Cardiol Ctr, Dept Anesthesiol, Kemerovo, Russia
Candela-Toha, AM:
Univ Hosp Ramon & Cajal, Dept Anesthesiol, Madrid, Spain
Demir, ZA:
Hlth Sci Univ, Ankara Bilkent City Hosp, Dept Anesthesiol, Ankara, Turkiye
Legros, V:
Univ Hosp, Hop Maison Blanche, Dept Anesthesiol & Crit Care, F-51100 Reims, France
Rosenberger, P:
Univ Hosp Tubingen, Dept Anesthesiol & Intens Care, Tubingen, Germany
Menendez, PG:
Univ Hosp Vall Hebron, Dept Anesthesiol & Intens Care, Barcelona, Spain
Alvarez, MG:
Univ Barcelona, Hosp St Pau, Dept Anesthesiol, Barcelona, Spain
Peng, K:
Soochow Univ, Affiliated Hosp 1, Dept Anesthesiol, Suzhou, Peoples R China
Leger, M:
Ctr Hosp Univ Angers, Dept Anesthesiol & Intens Care, Angers, France
Khalel, W:
Tripoli Cent Hosp, Dept Anesthesiol, Tripoli, Libya
Orhan-Sungur, M:
Univ Hosp Munster, Dept Anesthesiol Intens Care & Pain Med, Albert Schweitzer Campus 1,Gebaude A1, D-48149 Munster, Germany
Istanbul Univ, Istanbul Fac Med, Dept Anesthesiol & Reanimat, Istanbul, Turkiye
hybrid, All Open Access; Hybrid Gold
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