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Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury.
Joosten, Alexandre; Ickx, Brigitte; Mokthari, Zakaria; Van Obbergh, Luc; Lucidi, Valerio; Collange, Vincent; Naili, Salima; Ichai, Philippe; Samuel, Didier; Sa Cunha, Antonio; Alexander, Brenton; Legrand, Matthieu; Taccone, Fabio Silvio; Harrois, Anatole; Duranteau, Jacques; Vincent, Jean-Louis; Rinehart, Joseph; Van der Linden, Philippe.
Afiliação
  • Joosten A; Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium. Alexandre.Joosten@erasme.ulb.ac.be.
  • Ickx B; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France. Alexandre.Joosten@erasme.ulb.ac.be.
  • Mokthari Z; Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
  • Van Obbergh L; Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
  • Lucidi V; Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
  • Collange V; Department of Hepato-biliary Surgery, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
  • Naili S; Department of Anesthesiology, Médipole, Lyon Villeurbanne, France.
  • Ichai P; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
  • Samuel D; Department of Liver Intensive Care Unit, AP-HP, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
  • Sa Cunha A; Department of Liver Intensive Care Unit, AP-HP, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
  • Alexander B; Department of Hepato-biliary and Pancreatic Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
  • Legrand M; Department of Anesthesiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
  • Taccone FS; Department of Anesthesia and Perioperative care, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, USA.
  • Harrois A; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), INI-CRCT network, Paris, France.
  • Duranteau J; Department of Intensive Care, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
  • Vincent JL; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Bicetre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, 78 rue du General Leclerc, 94270, Le Kremlin Bicetre, France.
  • Rinehart J; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Bicetre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, 78 rue du General Leclerc, 94270, Le Kremlin Bicetre, France.
  • Van der Linden P; Department of Intensive Care, CUB Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070, Bruxelles, Belgium.
BMC Anesthesiol ; 21(1): 135, 2021 04 30.
Article em En | MEDLINE | ID: mdl-33931017
ABSTRACT

BACKGROUND:

The potential relationship between a mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery and its effect on long term renal function remains poorly defined. According to the "Kidney Disease Improving Global Outcomes" (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-h window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent intermediate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI.

METHODS:

All consecutive adult patients with a plasma creatinine value ≤1.5 mg/dl who underwent intermediate-to high-risk abdominal surgery between 2014 and 2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a "modified" (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-h or 1.5-1.9 times baseline) or moderate-to-severe (stage 2-3 characterised by increase in creatinine 2 to 3 times baseline or to ≥4.0 mg/dl). The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the same KDIGO initiative criteria. Development of long-term renal injury was compared in patients with and without postoperative AKI.

RESULTS:

Among the 815 patients included, 109 (13%) had postoperative AKI (81 mild and 28 moderate-to-severe). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P = 0.2). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7-5.5]; p < 0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8-11.4]; p = 0.002).

CONCLUSIONS:

Mild AKI after intermediate-to high-risk abdominal surgery is associated with a higher risk of long-term renal injury 1 y after surgery.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Creatinina / Insuficiência Renal Crônica / Injúria Renal Aguda Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Creatinina / Insuficiência Renal Crônica / Injúria Renal Aguda Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article