Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
- Autori: Meersch, Melanie; Weiss, Raphael; Strauß, Christian; Albert, Felix; Booke, Hendrik; Forni, Lui; Pittet, Jean-Francois; Kellum, John A.; Rosner, Mitchell; Mehta, Ravindra; Bellomo, Rinaldo; Rosenberger, Peter; Zarbock, Alexander; Makhloufi, Hichem; Sakhraoui, Rachida; Ouyahia, Amel; Rais, Mounira; Kouicem, Aya Tinhinane; Derwish, Khawla; Abdoun, Meriem; Ouahab, Ilhem; Bouaoud, Souad; Tidjane, Anisse; Rivera, Carlos Jose Pérez; García, Juan Pablo; Peng, Ke; Ji, Fu-hai; Ma, Zheng-min; Elbahnasawy, Mohamed Gamal; Elsalhawy, Shady; Nafea, Ahmed Mahmoud; Osman, Nermin A.; Emara, Moataz Maher; Bonna, Mohamed Mamdouh; Abdehaleem, Ibrahim Abdelmonaem; Abbas, Ahmed Mohamed; Abbas, Mostafa Samy; Esmaeil, Hany Mostafa; Joannes-Boyau, Oliver; Legros, Vincent; Floch, Thierry; Muccio, Salvatore; Menage-Innocenti, Lison; Brochet, Benjamin; Leclercq-Rouget, Marion; Geneve, Claire; Mocarquer, Bernardita Valenzuela; Aveline, Christophe; Vautier, Pierre; Nadaud, Julien; Rimmelé, Thomas; Cerro, Valérie; Suria, Stéphanie; Elmawieh, Jamie; El-Jawiche, Rita; Cirenei, Cédric; Lebuffe, Gilles; Ponsonnard, Sébastien; Egreteau, Pierre-Yves; Ichai, Carole; Jean-Michel, Vanessa; Léger, Maxime; Lasocki, Sigismond; Masson, Charline; Rineau, Emmanuel; Cassisa, Viviane; Verrier, Pierre; Atchade, Enora; Rochon, Charles-Edouard; Quentin, Vidal; Queixalos, Nina; Braun, Thierry; Grand, Hubert; Mayeur, Nicolas; Pasquie, Marie; Garçon, Pierre; Bruckert, Vincent; Pradel, Gaël; Ramorasata, Andersen; Ravry, Céline; Mottard, Nicolas; Zarbock, Alexander; Meersch, Melanie; Weiss, Raphael; von Groote, Thilo; Dörr, Christian; Küllmar, Mira; Massoth, Christina; Motekallemi, Arash; Saadat-Gilani, Khaschayar; Albert, Felix; Kerschke, Laura; Storck, Michael; Varghese, Julian; Wempe, Carola; Grüßer, Linda; Kowark, Ana; Brandenburger, Timo; Hohn, Andreas; Rosenberger, Peter; Häberle, Helene; Hofmann, Pascal; Kuhle, Jonathan; Calov, Stefanie; Bernard, Alice Marie; Mirakaj, Valbona; Weber, Kathrin; Pfister, Kathrin; Stetz, Lena; Müller, Sarah Dorothea; Klaus, Stephan; Sadlo, Marco; Sengelhoff, Christian; Stenger, Carina-Kristin; Göbel, Ulrich; Heringlake, Matthias; Arnaoutoglou, Eleni; Stratigopoulou, Panagiota; Danai, Pantazi; Dimakopoulou, Antonia; Menis, Apostolos-Alkiviadis; Ioannidis, Orestis; Jalaawiy, Humam; Anwar, Aeshah; Hashim, Hashim Talib; Aldawoody, Hogir Imad Rasheed; Cortegiani, Andrea; Ippolito, Mariachiara; Marino, Claudia; Presti, Gabriele; Fricano, Dario Calogero; De Rosa, Silvia; Bianchin, Andrea; Paternoster, Gianluca; Fasciano, Umberto; Cutuli, Salvatore Lucio; Savino, Spadaro; Enrico, Bussolati; Marco, Palmieri; Alberto, Volta Carlo; Tripodi, Vincenzo Francesco; Fiume, Diego; Iuorio, Angela; Santorsola, Clemente; Abu-Hussein, Bilal; Hasanein, Khaled; Shin, Seokyung; Baek, Jongyoon; Kim, Sehui; Elhadi, Muhammed; Aldressi, Wafa; Abuzeid, Issa A.; Albaraesi, Mohammed N.; Moftah, Mohamed Aziz; Aldressi, Sarah; Khalel, Wegdan; Abdulwahed, Eman; Alshareea, Entisar Ahmed Ali; Abujrad, Akram Abdulhamid Ashur; Ghmagh, Reem; Biala, Marwa Isa; Derwish, Khawla; Al Islam Benjouira, Rayet; Aliwa, Mohamed; Msherghi, Ahmed; Tuwaib, Ahmed; Mustafa, Tahani; Zriba, Haifa; Agilla, Hamza Mahmoud; Hamida, Bahaeddin Taher Sadek Ben; Otman, Rema Hassan Mohamed; Mijovska, Maja Mojsova; Podesta, Anne Marie Camilleri; López, Gilberto Adrián Gasca; Amro, Sarah; de Freitas Regufe, Rita; Grigoryev, Evgeny; Ivkin, Artem; Balakhnin, Dmitriy; Shukevich, Dmitriy; Yaroustovsky, Michael; Barmou, Abdulnaser; Kaserer, Alexander; Castellucci, Clara; Akbas, Samira; Petrun, Andreja Möller; Gregorcic, Irena; Sok, Vesna; Links, Andre; Barreto, Elizabeth Bárcena; Melchor, Javier Ripollés; Becerra-Bolaños, Ángel; Rodríguez-Pérez, Aurelio; Estévez, Javier Mata; Matas, Juan Mulet; Palao, Sara Pérez; Álvarez, Mercedes García; Albadalejo, Albert Bainac; González, Astrid Batalla; Caro, Ana María Gómez; Blanco, Ignacio Hinojal; Fernandez, Diego Toral; Perez, G
- Anno di pubblicazione: 2024
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/622898
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.