scholarly journals Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
Author(s):  
Diamantina Marouli ◽  
Kostas Stylianou ◽  
Eleftherios Papadakis ◽  
Nikolaos Kroustalakis ◽  
Stavroula Kolyvaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Care Center ◽  
Chronic Kidney Disease Stage ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Disease Stage ◽  
Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

scholarly journals 1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S540-S540
Author(s):  
Bhavana Surapareddy ◽  
Muralidhar Varma ◽  
Shashidhar V
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Early Recognition ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Significant Difference ◽  
Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

scholarly journals Intraoperative oliguria does not predict postoperative acute kidney injury in major abdominal surgery: a cohort analysis

2020 ◽  
Author(s):  
Rita Inácio ◽  
Joana Gameiro ◽  
Solange Amaro ◽  
Mafalda Duarte
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Hospital Mortality ◽  
Urine Output ◽  
Cohort Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Considerable Morbidity ◽  
Postoperative Aki

Abstract Background: Acute kidney injury (AKI) is a common complication in patients undergoing major abdominal surgery and is associated with considerable morbidity and mortality. Several studies investigating the association between intraoperative urine output and postoperative AKI have shown conflicting results. Here, we investigated the association of intraoperative oliguria with postoperative AKI in a cohort of patients submitted to elective major abdominal surgery. Methods: This was a single-center retrospective analysis of adult patients who underwent elective major abdominal surgery from January 2016 to December 2018. AKI was defined according to the serum creatinine criteria of the KDIGO classification. Intraoperative oliguria was defined as urine output of less than 0.5 mL/kg/h. Risk factors were evaluated using multivariate logistic regression analysis. Results: A total of 165 patients were analyzed. In the first 48 h after surgery the incidence of AKI was 19.4%. Postoperative AKI was associated with hospital mortality (p=0.011). Twenty percent of patients developed intraoperative oliguria. There was no association between preexisting comorbidities and development of intraoperative oliguria. There was no correlation between the type of anesthesia used and occurrence of intraoperative oliguria, but longer anesthesia time was associated with intraoperative oliguria (p=0.007). Higher baseline SCr (p=0.001), need of vasoactive drugs (p=0.007), and NSAIDs use (p=0.022) were associated with development of intraoperative oliguria. Intraoperative oliguria was not associated with development of postoperative AKI (p=0.772), prolonged hospital stays (p=0.176) or in-hospital mortality (p=0.820). Conclusion: In this cohort of patients we demonstrated that intraoperative oliguria does not predict postoperative AKI in major abdominal surgery.

scholarly journals Acute Kidney Injury after Major Abdominal Surgery: A Retrospective Cohort Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Catarina Teixeira ◽  
Rosário Rosa ◽  
Natacha Rodrigues ◽  
Inês Mendes ◽  
Lígia Peixoto ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Hospital Mortality ◽  
Risk Index ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Cardiac Risk ◽  
Simplified Acute Physiology Score ◽  
Major Abdominal Surgery ◽  
Postoperative Aki

Background. We analyzed the incidence, risk factors, and prognosis of acute kidney injury (AKI) in a cohort of patients undergoing major abdominal surgery.Methods. A total of 450 patients were retrospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dl or by an increase in SCr ≥ 50% and/or by a decrease in urine output to 0.5 ml/kg/hour for 6 hours, in the first 48 hours after surgery. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailedPvalue <0.05 was considered significant.Results. One hundred one patients (22.4%) had postoperative AKI. Age (adjusted odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05), nonrenal Revised Cardiac Risk Index score (adjusted OR 1.9, 95% CI 1.3–3.1,P=0.003), intraoperative erythrocytes transfusions (adjusted OR 2.2, 95% CI 1.4–3.5,P <.0001), and nonrenal Simplified Acute Physiology Score II (adjusted OR 1.03, 95% CI 1.01–1.06,P=0.0191) were associated with postoperative AKI. AKI was associated with increased in-hospital mortality (20.8% versus 2.3%,P <.0001; unadjusted OR 11.2, 95% CI 4.8–26.2,P <.0001; adjusted OR 3.7, 95% CI 1.2–11.7,P=0.024).Conclusion. AKI was common in patients undergoing major abdominal surgery and was associated with in-hospital mortality.

scholarly journals Incidence, risk factors and outcomes of postoperative acute kidney injury in elderly patients undergoing abdominal surgery

2019 ◽  
Author(s):  
Jianghua Shen ◽  
Simiao Zhao ◽  
Denglei Ma ◽  
Minghui Chen ◽  
Suying Yan
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Kidney Injury ◽  
Intraoperative Management ◽  
Combined Administration ◽  
Incidence Risk ◽  
Independent Risk Factors ◽  
Postoperative Aki

Abstract Objectives To investigate the incidence, risk factors and outcomes of acute kidney injury (AKI) in elderly patients undergoing abdominal surgery. Methods A retrospective study exploring the incidence of AKI in patients older than 75 years within 48 hours after abdominal surgery was conducted. Patients' preoperative characteristics, intraoperative management including medication and outcomes were evaluated for associations with AKI using a logistic regression model.Results During the 2.5-year period, a total of 409 abdominal surgeries were performed. Both pre- and post-operative SCr measurements were available for 329 (80.4%) cases. 26 patients (7.9%) developed AKI, of whom 25 (7.6%) and 1 (0.3%) reached the AKI stages 1 and 2 respectively. Older age (83.0 vs 80.4 years; p=0.002), preoperative liver function damage represented by AST (47.5 vs 21.0 IU/L; p=0.023), intraoperative combined administration of hydroxyethyl starch(HES) and furosemide (15.38% vs 1.65%; p=0.003) were independent risk factors for the development of postoperative AKI. Furthermore, AKI patients had significantly longer ICU stay (3 vs 0 days; p<0.001) and higher in-hospital mortality (23.08% vs 2.31%; p<0.001)Conclusion Intraoperative combined administration of HES and furosemide is an independent factor which can be controlled by anesthesiologists and surgeons for AKI. This provides important recommendations for reducing the incidence of postoperative AKI.

scholarly journals Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

2020 ◽  
Vol 9 (8) ◽  
pp. 2679
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
Filipe Marques ◽  
José António Lopes
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Patient Characteristics ◽  
Major Abdominal Surgery ◽  
Comprehensive Review ◽  
Postoperative Aki ◽  
Long Term Mortality

Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery.

scholarly journals Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
Marta Neves ◽  
Sofia Jorge ◽  
José António Lopes
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Incidence Risk ◽  
Surgery Incidence

scholarly journals The Impact of Propofol- and Inhalant-Based Anesthesia on Acute Kidney Injury After Major Abdominal Surgery: A Retrospective Observational Study

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Susie Yoon ◽  
Gyu Young Song ◽  
Seohee Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Propensity Score ◽  
Abdominal Surgery ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Regression Analyses ◽  
Inverse Probability ◽  
The Impact ◽  
Postoperative Aki

Abstract Background: The optimal anesthetic for preventing postoperative acute kidney injury (AKI) remains unclear, and few studies on this topic have been conducted in the context of non-cardiac surgery. The purpose of this retrospective study was to compare propofol- and inhalant-based anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS).Methods: Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from January 2016 to December 2018 were included. Using multivariable logistic regression, the risk of postoperative AKI was compared between patients who underwent propofol-based anesthesia (propofol group) and those who received inhalant-based anesthesia (inhalant group). Additional logistic regression analyses were performed after propensity score matching and inverse probability of treatment weighting (IPTW).Results: In total, 3,616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the propofol and inhalant groups, respectively. The risk of AKI was significantly higher in the inhalant group (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.23–2.30; P= 0.001) than the propofol group. In the propensity score-matched cohort, the inhalant group had a higher risk of AKI than the propofol group (aOR, 1.68; 95% CI, 1.21–2.34; P= 0.002), and the logistic regression with IPTW showed similar results (OR, 1.74; 95% CI 1.14–1.66; P< 0.001).Conclusion: The risk of AKI after open MAS may differ significantly according to the anesthetic used. Patients receiving inhalant-based anesthesia may have a greater risk of postoperative AKI than those anaesthetized with propofol.

Sign in / Sign up

Export Citation Format

Share Document