Browsing by Subject "Renal Insufficiency, Chronic"

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    Bone mineral density and biochemical markers of bone metabolism in predialysis patients with chronic kidney disease
    (Lippincott Williams and Wilkins, 2016) Fidan N.; Inci A.; Coban M.; Ulman C.; Kursat S.
    The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90±12 (range=6.0-56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p<0.05). According to different BMD T score levels, patients with age ≥65 years and patients in menopause were significantly more osteopenic ( p=0.026) and there was no relation between different BMD T scores and presence of diabetes ( p=0.654). A positive correlation was identified between the BMD of FN T-Z scores (r=0.270, p=0.029, r=0.306, p=0.012), FT T-Z scores (r=0.220, p=0.076, r:0.250, p=0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD. © 2016 American Federation for Medical Research.
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    Effects of nutritional Vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease
    (Oxford University Press, 2018) Lerch C.; Shroff R.; Wan M.; Rees L.; Aitkenhead H.; Bulut I.K.; Thurn D.; Bayazit A.K.; Niemirska A.; Canpolat N.; Duzova A.; Azukaitis K.; Yilmaz E.; Yalcinkaya F.; Harambat J.; Kiyak A.; Alpay H.; Habbig S.; Zaloszyc A.; Soylemezoglu O.; Candan C.; Rosales A.; Melk A.; Querfeld U.; Leifheit-Nestler M.; Sander A.; Schaefer F.; Haffner D.; Cortina G.; Arbeiter K.; Dusek J.; Ranchin B.; Fischbach M.; Zalosczyk A.; Galiano M.; Büscher R.; Gimpel C.; Kemper M.; Doyon A.; Wühl E.; Pohl M.; Wygoda S.; Jeck N.; Kranz B.; Wigger M.; Montini G.; Lugani F.; Testa S.; Vidal E.; Matteucci C.; Picca S.; Jankauskiene A.; Zurowska A.; Drodz D.; Tkaczyk M.; Urasinski T.; Litwin M.; Szczepanska M.; Texeira A.; Peco-Antic A.; Bucher B.; Laube G.; Anarat A.; Basin E.; Cakar N.; Bilginer Y.; Erdogan H.; Donmez O.; Balat A.; Caliskan S.; Civilibal M.; Emre S.; Ozcelik G.; Mir S.; Sözeri B.; Yavascan O.; Tabel Y.; Ertan P.; Prytula A.; Bachetta J.; Klaus G.; Geßner M.; Schmitt C.P.; Stabouli S.; Reusz G.; Verrina E.; Groothoff J.; Tondel C.; Gamero M.A.; Petrosyan E.; Bakkaloglu S.A.; Dursun I.
    Background: We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23(FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). Methods: In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m2], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. Results: Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and - 1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70mL/min/1.73m2. Conclusions: Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD. © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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    Indoxyl sulfate associates with cardiovascular phenotype in children with chronic kidney disease
    (Springer Verlag, 2019) Holle J.; Querfeld U.; Kirchner M.; Anninos A.; Okun J.; Thurn-Valsassina D.; Bayazit A.; Niemirska A.; Canpolat N.; Bulut I.K.; Duzova A.; Anarat A.; Shroff R.; Bilginer Y.; Caliskan S.; Candan C.; Harambat J.; Özcakar Z.B.; Soylemezoglu O.; Tschumi S.; Habbig S.; Yilmaz E.; Balat A.; Zurowska A.; Cakar N.; Kranz B.; Ertan P.; Melk A.; Azukaitis K.; Schaefer F.
    Background: Cardiovascular disease is the leading cause of death in children with chronic kidney disease (CKD). Serum levels of gut-derived uremic toxins increase with deterioration of kidney function and are associated with cardiac comorbidities in adult CKD patients. Methods: Indoxyl sulfate (IS) and p-cresyl sulfate (pCS) were measured by high-performance liquid chromatography in serum of children participating in the Cardiovascular Comorbidity in Children with CKD (4C) Study. Results were correlated with measurements of the carotid intima-media thickness (cIMT), central pulse wave velocity (PWV), and left ventricular mass index (LVMI) in children aged 6–17 years with initial eGFR of 10–60 ml/min per 1.73 m2. Results: The median serum levels of total IS and of pCS, measured in 609 patients, were 5.3 μmol/l (8.7) and 17.0 μmol/l (21.6), respectively. In a multivariable regression model, IS and pCS showed significant positive associations with urea and negative associations with eGFR and uric acid. Furthermore, positive associations of pCS with age, serum albumin, and non-Mediterranean residency and a negative association with glomerular disease were observed. By multivariable regression analysis, only IS was significantly associated with a higher cIMT SDS at baseline and progression of PWV SDS within 12 months, independent of other risk factors. Conclusions: Serum levels of gut-derived uremic toxins IS and pCS correlated inversely with eGFR in children. Only IS was significantly associated with surrogate markers of cardiovascular disease in this large pediatric CKD cohort. © 2019, IPNA.
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    Low levels of urinary epidermal growth factor predict chronic kidney disease progression in children
    (Elsevier B.V., 2019) Azukaitis K.; Ju W.; Kirchner M.; Nair V.; Smith M.; Fang Z.; Thurn-Valsassina D.; Bayazit A.; Niemirska A.; Canpolat N.; Bulut I.K.; Yalcinkaya F.; Paripovic D.; Harambat J.; Cakar N.; Alpay H.; Lugani F.; Mencarelli F.; Civilibal M.; Erdogan H.; Gellermann J.; Vidal E.; Tabel Y.; Gimpel C.; Ertan P.; Yavascan O.; Melk A.; Querfeld U.; Wühl E.; Kretzler M.; Schaefer F.; Arbeiter K.; Rosales A.; Dusek J.; Zaloszyc A.; Liebau M.; Weber L.; Muschiol E.; Büscher R.; Oh J.; Thurn-Valassina D.; Haffner D.; John U.; Wygoda S.; Jeck N.; Wigger M.; Testa S.; Murer L.; Matteucci C.; Jankauskiene A.; Drozdz D.; Zurowska A.; Zaniew M.; Litwin M.; Nimierska A.; Teixeira A.; Peco-Antic A.; Laube G.; Anarat A.; Duzova A.; Bilginer Y.; Caliskan S.; Mir S.; Sözeri B.; Kranz B.; Dorn B.; Baskin E.; Soylemezoglu O.; Emre S.; Candan C.; Kiyak A.; Ozcelik G.; Shroff R.; Rachin B.; Szczepanska M.; Donmez O.; Balat A.; Aksu N.; Yilmaz E.; Bakkaloglu A.; Ozaltin F.; Sallay P.; Bonzel K.-E.; Wingen A.-M.; Balasz I.; Trivelli A.; Perfumo F.; Müller-Wiefel D.-E.; Möller K.; Offner G.; Enke B.; Hadtstein C.; Mehls O.; Hohbach-Hohenfellner K.; Jeck N.; Klaus G.; Ardissino G.; Montini G.; Charbit M.; Niaudet P.; Afonso A.C.; Fernandes-Teixeira A.; Picca S.; Berg U.B.; Celsi G.; Fischbach M.; Terzic J.; Fydryk J.; Urasinski T.; Coppo R.; Peruzzi L.; Grenda R.; Neuhaus T.J.
    Urinary epidermal growth factor (uEGF) has recently been identified as a promising biomarker of chronic kidney disease (CKD) progression in adults with glomerular disease. Low levels of uEGF predict CKD progression and appear to reflect the extent of tubulointerstitial damage. We investigated the relevance of uEGF in pediatric CKD. We performed a post hoc analysis of the Cardiovascular Comorbidity in Children with CKD (4C) study, which prospectively follows children aged 6–17 years with baseline estimated glomerular filtration rate (eGFR) of 10–60 ml/min/1.73 m2. uEGF levels were measured in archived urine collected within 6 months of enrollment. Congenital abnormalities of the kidney and urinary tract were the most common cause of CKD, with glomerular diseases accounting for <10% of cases. Median eGFR at baseline was 28 ml/min/1.73 m2, and 288 of 623 participants (46.3%) reached the composite endpoint of CKD progression (50% eGFR loss, eGFR < 10 ml/min/1.73 m2, or initiation of renal replacement therapy). In a Cox proportional hazards model, higher uEGF/Cr was associated with a decreased risk of CKD progression (HR 0.76; 95% CI 0.69–0.84) independent of age, sex, baseline eGFR, primary kidney disease, proteinuria, and systolic blood pressure. The addition of uEGF/Cr to a model containing these variables resulted in a significant improvement in C-statistics, indicating better prediction of the 1-, 2- and 3-year risk of CKD progression. External validation in a prospective cohort of 222 children with CKD demonstrated comparable results. Thus, uEGF may be a useful biomarker to predict CKD progression in children with CKD. © 2019 International Society of Nephrology
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    Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease
    (Blackwell Publishing, 2020) Toraman A.; Eren B.; Yılmaz I.; Duzgun F.; Taneli F.; Kursat S.
    Background: Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. Aims: To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease. Methods: A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima-media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12-lead electrocardiogram recording was used to detect fQRS. Results: The mean age was 55.1 ± 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 ± 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(−) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (β = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease–glomerular filtration rate)). Conclusions: This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease. © 2020 Royal Australasian College of Physicians
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    Predicting factors of acute kidney injury after partial nephrectomy and its impact on long-term renal function: A multicentre study of the Turkish Urooncology Association
    (John Wiley and Sons Inc, 2021) Suer E.; Akpinar C.; Izol V.; Bayazit Y.; Sozen S.; Cetin S.; Ozden E.; Turkeri L.; Bozkurt O.; Ucer O.; Baltaci S.
    Objectives: To investigate the predictors of acute kidney injury (AKI) after partial nephrectomy and the impact of AKI stage on long-term kidney function. Methods: Data of 1055 patients who underwent partial nephrectomy between January 2008 and January 2018 at seven separate tertiary centres were analysed. AKI was defined according to AKI Network criteria. The association between pre-operative and perioperative factors and AKI was evaluated using logistic regression analysis. Recovery of at least 90% of baseline glomerular filtration rate 1 year after partial nephrectomy, change of 1 year glomerular filtration rate compared with baseline glomerular filtration rate and stage ≥3 chronic kidney disease (CKD) progression were assessed according to the stage of AKI. Results: AKI was recorded in 281 (26.7%) of 1055 patients after partial nephrectomy, and of these patients, 197 (70.1%) had stage 1, 77 (27.4%) had stage 2 and 7 (2.5%) had stage 3. Higher tumour complexity and baseline glomerular filtration rate were independent predictors for AKI. The proportion of recovering 90% of baseline glomerular filtration rate at 1 year for any patient who had stage ≤1 vs stage 2-3 of AKI was 78.2% (95% CI: 73.2%-83.7%) and 23.8% (95% CI: 14.7%-38.7%), respectively (P <.001). The risk of stage ≥3 CKD progression for any patient who had stage ≤1 vs stage 2-3 of AKI was 6.2% (95% CI: 4.1%-9.2%) and 63.1% (95% CI: 52.5%-75.6%), respectively (P <.001). Conclusions: AKI adversely affects renal function in the long-term after partial nephrectomy and stage 2-3 significantly increases the risk of CKD in the long term. © 2021 John Wiley & Sons Ltd.
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    Can Aortic and Renal Arteries Calcium Scores Be New Factors to Predict Post-Operative Renal Function After Nephron Sparing Surgery?
    (Elsevier Inc., 2022) Akarken İ.; Bilen C.Y.; Özden E.; Gülşen M.; Üçer O.; Şahin H.
    Introduction: This study aims to investigate whether the calcification of renal arteries and aorta may be risk factors for developing chronic kidney disease (CKD) after Nephron sparing surgery (NSS). Materials and Methods: The patients that underwent either open or laparoscopic NSS from 2000 to 2019 in 4 different centers were retrospectively assessed. Of these patients, 328 had a non-contrast-enhanced computer tomography. Calcium scores of the renal arteries and abdominal aorta were measured in the non-contrast-enhanced images with the calcium score plugin (version 2.0) of Horos™. Univariate and multivariate logistic regression analysis was performed to determine significant risk factors for developing CKD at the last check-up. Roc curve analysis was performed to determine the optimal cut-off values of age and abdominal aorta calcium scores. Results: A total of 302 patients, of which 52 (16,6%) with CKD and 252 (83,4%) without CKD at the last check-up, were included in the analysis. The mean warm ischemia duration was significantly higher in patients with CKD (18,79±6,72 vs 16,38±5,57 minutes, p=0,016). The mean size of the tumor diameter and the number of the patients with ≥stage T1b were higher in the group with CKD (p=0,024 and 0,005, respectively). The median calcium scores of the aorta and renal arteries were higher in the group with CKD (p<0,001 and p<0,001, respectively). In multivariate analysis, age >60 years (OR:3,65, p=0,022), calcium score of the aorta (OR:4,07, p=0,029), tumor diameter (OR:1,03, p=0,026) and pre-operative CKD stage (OR:10,13, p<0,001) found the be significant factors for predicting last check-up CKD. Conclusion: The calcium score of the aorta may be used as an additional risk factor to predict post-operative CKD risk after NSS with sensitivity over 80%. © 2021
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    Kidney disease profile and encountered problems during follow-up in Syrian refugee children: a multicenter retrospective study
    (Springer Science and Business Media Deutschland GmbH, 2022) Balat A.; Kilic B.D.; Aksu B.; Kara M.A.; Buyukcelik M.; Agbas A.; Eroglu F.K.; Gungor T.; Alaygut D.; Yildiz N.; Bastug F.; Atmis B.; Melek E.; Elmaci M.; Tulpar S.; Pehlivanoglu C.; Doven S.S.; Comak E.; Tabel Y.; Gemici A.; Uysal B.; Ozzorlar G.S.; Kuçuk N.; Delibas A.; Ozcelik G.; Goknar N.; Dursun I.; Ertan P.; Ozunan I.A.; Sonmez F.
    Background: Children are one of the most vulnerable groups in conflict zones, especially those with chronic diseases. This study aimed to investigate kidney disease profiles and problems during follow-up in a population of Syrian refugee children residing in Turkey. Methods: Syrian refugee children aged between 0 and 18 years were included in the study. Demographic data, diagnosis, particular interventions due to nephrological problems, and problems encountered during follow-up were obtained from all participating pediatric nephrology centers. Results: Data from 633 children from 22 pediatric nephrology centers were included. Mean age of the children was 94.8 ± 61.7 months and 375 were male (59%). 57.7% had parental consanguinity and 23.3% had a close relative(s) with kidney disease. The most common kidney diseases were congenital anomalies of the kidney and urinary tract (CAKUT) (31.0%), glomerular disease (19.9%), chronic kidney disease (CKD) (14.8%), and urolithiasis (10.7%). Frequent reasons for CAKUT were nonobstructive hydronephrosis (23.0%), vesico-ureteral reflux (18.4%), and neurogenic bladder (15.8%). The most common etiology of glomerular diseases was nephrotic syndrome (69%). Ninety-four children had CKD, and 58 children were on chronic dialysis. Six children had kidney transplantation. Surgical intervention was performed on 111 patients. The language barrier, lack of medical records, and frequent disruptions in periodic follow-ups were the main problems noted. Conclusions: CAKUT, glomerular disease, and CKD were highly prevalent in Syrian refugee children. Knowing the frequency of chronic diseases and the problems encountered in refugees would facilitate better treatment options and preventive measures. © 2021, IPNA.
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    Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
    (Springer Science and Business Media Deutschland GmbH, 2024) Meersch M.; Weiss R.; Strauß C.; Albert F.; Booke H.; Forni L.; Pittet J.; Kellum J.A.; Rosner M.; Mehta R.; Bellomo R.; Rosenberger P.; Zarbock A.; Makhloufi H.; Sakhraoui R.; Ouyahia A.; Rais M.; Kouicem A.T.; Derwish K.; Abdoun M.; Ouahab I.; Bouaoud S.; Tidjane A.; Pérez Rivera C.J.; García J.P.; Peng K.; Ji F.-H.; Ma Z.-M.; Elbahnasawy M.G.; Elsalhawy S.; Nafea A.M.; Osman N.A.; Emara M.M.; Bonna M.M.; Abdehaleem I.A.; Abbas A.M.; Abbas M.S.; Esmaeil H.M.; Joannes-Boyau O.; Legros V.; Floch T.; Muccio S.; Menage-Innocenti L.; Brochet B.; Leclercq-Rouget M.; Geneve C.; Mocarquer B.V.; Aveline C.; Vautier P.; Nadaud J.; Rimmelé T.; Cerro V.; Suria S.; Elmawieh J.; El-Jawiche R.; Cirenei C.; Lebuffe G.; Ponsonnard S.; Egreteau P.-Y.; Ichai C.; Jean-Michel V.; Léger M.; Lasocki S.; Masson C.; Rineau E.; Cassisa V.; Verrier P.; Atchade E.; Rochon C.-E.; Quentin V.; Queixalos N.; Braun T.; Grand H.; Mayeur N.; Pasquie M.; Garçon P.; Bruckert V.; Pradel G.; Ramorasata A.; Ravry C.; Mottard N.; von Groote T.; Dörr C.; Küllmar M.; Massoth C.; Motekallemi A.; Saadat-Gilani K.; Kerschke L.; Storck M.; Varghese J.; Wempe C.; Grüßer L.; Kowark A.; Brandenburger T.; Hohn A.; Häberle H.; Hofmann P.; Kuhle J.; Calov S.; Bernard A.M.; Mirakaj V.; Weber K.; Pfister K.; Stetz L.; Müller S.D.; Klaus S.; Sadlo M.; Sengelhoff C.; Stenger C.-K.; Göbel 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 S.; Bianchin A.; Paternoster G.; 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 López 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-Bolaños Á.; Rodríguez-Pérez A.; Estévez J.M.; Matas J.M.; Palao S.P.; Álvarez M.G.; Albadalejo A.B.; González 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.; García-Sánchez J.I.; Zamorano S.G.; Herreros N.G.; Callejas R.; Gómez M.E.; Candela-Toha A.M.; Claros-Llamas E.; Cobeta-Orduña P.; Crespo-Aliseda P.; Dorado-Díaz T.; Gómez-Rojo M.; Mané-Ruiz M.N.; González M.C.M.; Martínez-Pérez A.; Tiscar C.; Menéndez P.G.; Calvo V.E.; Espí L.L.; Aldeán Y.S.L.; Ariza V.M.; Vila L.V.; García-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.; Dinçer M.B.; Yildirim S.A.; Iyigun M.; Yapıcı D.; Özdemir L.; Sagün A.; Boztug N.; Gündüz 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.; Kızılcık N.; Şen Ö.; Darçın K.; Uğur S.; Gürkan Y.; Saracoglu K.T.; Yıldız-Koyuncu Ö.; Demir Z.A.; Postacı N.A.; Özgök A.; Karadeniz Ü.; Özay H.Y.; Balcı E.; Salman N.; Girgin B.; Sagir O.; Demir H.F.; Ugun F.; Toprak H.İ.; Özcan M.S.; Alkaya-Solmaz F.; Yilmaz M.; Karaca U.; Şahin S.H.; Erkoç S.K.; Alkış N.; Baytaş V.; Erturk E.; Saylan S.; Akdogan A.; Yeşil B.B.; Boran O.F.; Orak Y.; Çalişir F.; Büyükçoban S.; Kuvaki B.; Cansabuncu S.; Akesen S.; Gören S.; Yeniocak T.; Orman O.; Karka Ö.E.; Sahin T.; Momot N.; Panchenko A.; Rutledge K.
    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. © The Author(s) 2024.