Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

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dc.date.accessioned2024-07-22T08:01:36Z
dc.date.available2024-07-22T08:01:36Z
dc.date.issued2024
dc.description.abstractPurpose: 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.
dc.identifier.DOI-ID10.1007/s00134-023-07314-2
dc.identifier.issn03424642
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/11509
dc.language.isoEnglish
dc.publisherSpringer Science and Business Media Deutschland GmbH
dc.rightsAll Open Access; Hybrid Gold Open Access
dc.subjectAcute Disease
dc.subjectAcute Kidney Injury
dc.subjectHumans
dc.subjectKidney
dc.subjectProspective Studies
dc.subjectRenal Insufficiency, Chronic
dc.subjectacetylsalicylic acid
dc.subjectaminoglycoside
dc.subjectangiotensin receptor antagonist
dc.subjectbeta adrenergic receptor blocking agent
dc.subjectcontrast medium
dc.subjectcyclosporine
dc.subjectdipeptidyl carboxypeptidase inhibitor
dc.subjectdiuretic agent
dc.subjectepinephrine
dc.subjecthydroxymethylglutaryl coenzyme A reductase inhibitor
dc.subjecthypertensive factor
dc.subjectnonsteroid antiinflammatory agent
dc.subjectnoradrenalin
dc.subjecttacrolimus
dc.subjectvancomycin
dc.subjectacute kidney failure
dc.subjectadult
dc.subjectAmerican Society of Anaesthesiologists score
dc.subjectArticle
dc.subjectatrial fibrillation
dc.subjectbronchospasm
dc.subjectcerebrovascular accident
dc.subjectchronic kidney failure
dc.subjectchronic obstructive lung disease
dc.subjectclinical outcome
dc.subjectclinical trial (topic)
dc.subjectcohort analysis
dc.subjectcomorbidity
dc.subjectcongestive heart failure
dc.subjectcontrolled study
dc.subjectcreatinine blood level
dc.subjectdeath
dc.subjectdiabetes mellitus
dc.subjectdisease duration
dc.subjectdisease exacerbation
dc.subjectdisease severity
dc.subjectdrug exposure
dc.subjectestimated glomerular filtration rate
dc.subjectfemale
dc.subjectheart atrium flutter
dc.subjectheart infarction
dc.subjectheart surgery
dc.subjecthuman
dc.subjecthypertension
dc.subjectmajor clinical study
dc.subjectmajor surgery
dc.subjectmale
dc.subjectmiddle aged
dc.subjectmulticenter study
dc.subjectobservational study
dc.subjectperioperative period
dc.subjectperipheral vascular disease
dc.subjectpneumonia
dc.subjectpostoperative care
dc.subjectpostoperative complication
dc.subjectprospective study
dc.subjectpulmonary aspiration
dc.subjectrisk factor
dc.subjectsecondary analysis
dc.subjectsepsis
dc.subjectsurvivor
dc.subjecturologic surgery
dc.subjectvascular surgery
dc.subjectacute disease
dc.subjectacute kidney failure
dc.subjectchronic kidney failure
dc.subjectclinical trial
dc.subjectkidney
dc.titleAcute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
dc.typeArticle

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