Retrospective investigation of acute kidney injury in postoperative patients in ICU

Aims: The development of acute kidney injury (AKI) in the postoperative period is associated with increased morbidity and mortality. This study aims to determine the incidence of postoperative acute kidney injury (AKI) and the factors affecting the development of AKI in the intensive care unit (ICU) and to evaluate the outcomes of the patients. Methods: Postoperative patients hospitalized in the ICU between December 2021 and January 2023 were retrospectively analyzed, and 192 patients were included in the study. Kidney disease: patients with and without AKI were identified using the improving global outcomes (KDIGO) criteria. Results: While 150 of the patients did not develop AKI (non-AKI group), 42 of them developed acute kidney injury (AKI group). The patients were operated on mostly by the orthopedics clinic (58.9%) and operated on at least by the urology clinic (2.1%) were taken to the intensive care unit. 39.6% of the patients underwent emergency surgery, and 60.4% underwent elective surgery. 57.1% of the AKI group and 34.7% of the non-AKI group had emergency surgery (p=0.008). Conclusion: In our study, age, timing of surgery, use of diuretics, and use of vasopressors were found to be associated with the development of postoperative AKI. In addition, comorbid diseases such as diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease have also been found to be associated with AKI. Mortality, length of stay in the intensive care unit, and need for mechanical ventilation (MV) were also higher in our postoperative intensive care patients who developed AKI than in patients who did not develop AKI.

Keywords:

Intensive care, acute kidney injury, KDİGO, postoperative mortality,

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Boyer N, Eldridge J, Prowle JR, Forni LG. Postoperative acute kidney injury. Clin J Am Soc Nephrol. 2022;17(10):1535-1545. doi:10.2215/CJN.16541221
Prowle JR, Forni LG, Bell M, et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the acute disease quality initiative and perioperative quality initiative. Nat Rev Nephrol. 2021;17(9):605-618. doi:10.1038/s41581-021-00418-2
Lee HJ, Bae J, Kwon Y, et al. General anesthetic agents and renal function after nephrectomy. J Clin Med. 2019;8(10):1530. doi:10.3390/jcm8101530
Nash DM, Mustafa RA, McArthur E, et al. Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study. Can J Anaesth. 2015;62(4):356-368.
Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth. 2015;115 Suppl 2:ii3-ii14. doi:10.1093/bja/aev380
Ostermann M, Bellomo R, Burdmann EA, et al. Controversies in acute kidney injury:Conclusion from a kidney disease: improving global outcomes (KDIGO) conference. Kidney Int. 2020;98(2):294-309. doi:10.1016/j.kint.2020.04.020
Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. 2009;13(3):R79.
Lone Z, Zhang A, Benidir T, et al. The role of enhanced recovery after surgery protocols in the development of acute kidney injury following radical cystectomy. Urol Oncol. 2022;40(10):453.e1-453.e7. doi:10.1016/j.urolonc.2022.07.004
Park S, Cho H, Park S, et al. Simple postoperative AKI risk (SPARK) classification before noncardiac surgery: a prediction index development study with external validation. J Am Soc Nephrol. 2019;30(1):170-181. doi:10.1681/ASN.2018070757
Zhang Y, Zhang X, Xi X, Dong W, Zhao Z, Chen S. Development and validation of AKI prediction model in postoperative critically ill patients:a multicenter cohort study. Am J Transl Res. 2022;14(8):5883-5895.
Kim JM, Jo YY, Na SW, et al. The predictors for continuous renal replacement therapy in liver transplant recipients. Transplant Proc. 2014;46(1):184-191. doi:10.1016/j.transproceed.2013.07.075
Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA. Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol. 2012;13:101. doi:10.1186/1471-2369-13-101
Zarbock A, Koyner JL, Hoste EAJ, Kellum JA. Update on perioperative acute kidney injury. Anesth Analg. 2018;127(5):1236-1245. doi:10.1213/ANE.0000000000003741
Puckett JR, Pickering JW, Palmer SC, et al. Low versus standard urine output targets in patients undergoing major abdominal surgery:a randomized noninferiority trial. Ann Surg. 2017;265(5):874-881. doi:10.1097/SLA.0000000000002044
Priyanka P, Zarbock A, Izawa J, Gleason TG, Renfurm RW, Kellum JA. The impact of acute kidney injury by serum creatinine or urine output criteria on major adverse kidney events in cardiac surgery patients. J Thorac Cardiovasc Surg. 2021;162(1):143-151.e7. doi:10.1016/j.jtcvs.2019.11.137
Mizota T, Yamamoto Y, Hamada M, Matsukawa S, Shimizu S, Kai S. Intraoperative oliguria predicts acute kidney injury after major abdominal surgery. Br J Anaesth. 2017;119(6):1127-1134. doi:10.1093/bja/aex255
Ariyarathna D, Bhonsle A, Nim J, et al. Intraoperative vasopressor use and early postoperative acute kidney injury in elderly patients undergoing elective noncardiac surgery. Ren Fail. 2022;44(1):648-659. doi:10.1080/0886022X.2022.2061997
Cavallaro P, Bordeianou L. Implementation of an ERAS Pathway in Colorectal Surgery. Clin Colon Rectal Surg. 2019;32(2):102-108. doi:10.1055/s-0038-1676474
Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378(24):2263-2274. doi:10.1056/NEJMoa1801601
Shen W, Wu Z, Wang Y, Sun Y, Wu A. Impact of enhanced recovery after surgery (ERAS) protocol versus standard of care on postoperative acute kidney injury (AKI):A meta-analysis. PLoS One. 2021;16(5):e0251476. doi:10.1371/journal.pone.0251476
Biteker M, Dayan A, Tekkesin AI, et al. Incidence, risk factors, andoutcomes of perioperativeacutekidneyinjury in non-cardiacandnonvascularsurgery. Am J Surg. 2014;207:53-59.
Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110(3):505-515. doi:10.1097/ALN.0b013e3181979440
Kim M, Brady JE, Li G. Variations in the risk of acute kidney injury across intraabdominal surgery procedures. Anesth Analg. 2014;119(5):1121-1132. doi:10.1213/ANE.0000000000000425
Boyer N, Eldridge J, Prowle JR, Forni LG. Postoperative acute kidney injury. Clin J Am Soc Nephrol. 2022;17(10):1535-1545.
Prowle JR, Forni LG, Bell M, et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the acute disease quality initiative and perioperative quality initiative. Nat Rev Nephrol. 2021;17:605-618.
Lee HJ, Bae J, Kwon Y, et al. General anesthetic agents and renal function after nephrectomy. J Clin Med. 2019;8(10):1530.
Nash DM, Mustafa RA, McArthur E, et al. Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study. Can J Anaesth. 2015;62 (4):356-368.
Prowle JR, Forni LG, Bell M, et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the acute disease quality initiative and perioperative quality initiative. Nat Rev Nephrol. 2021;17(9):605-618.
Gündüz E ve Aydoğdu Titiz T. Biomarkers in the detection of acute renal injury associated with cardiac surgery. GKDA Derg. 2019;25(2):79-88.
Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth. 2015;115(2):3-14.
Ostermann M, Bellomo R, Burdmann EA, et al. Conference Participants. Controversies in acute kidney injury: Conclusion from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2020;98(2):294-309.
Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. 2009;13(3):79.
Lone Z, Zhang A, Benidir T, et al. The role of enhanced recovery after surgery protocols in the development of acute kidney injury following radical cystectomy. Urol Oncol. 2022;40(10):453.
Park S, Cho H, Park S, et al. Simple postoperative AKI risk (SPARK) classification before non-cardiac surgery: a prediction index development study with external validation. J Am Soc Nephrol. 2019;30:170-181.
Zhang Y, Zhang X, Xi X, Dong W, Zhao Z, Chen S. Development and validation of AKI prediction model in postoperative critically ill patients:a multicenter cohort study. Am J Transl Res. 2022;14(8):5883-5895.
Kim JM, Jo YY, Na SW, et al. The predictors for continuous renal replacement therapy in liver transplant recipients. Transplant Proc. 2014;46(1):184-191.
Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA. Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol. 2012;13:101.
Zarbock A, Koyner JL, Hoste EAJ, Kellum JA: update on perioperative acute kidney injury. Anesth Analg. 2018;127:1236-1245.
Puckett JR, Pickering JW, Palmer SC, et al. Low versus standard urine output targets in patients undergoing major abdominal surgery:A randomized noninferiority trial. Ann Surg. 2017;265:874-881.
Priyanka P, Zarbock A, Izawa J, Gleason TG, Renfurm RW, Kellum JA. The impact of acute kidney injury by serum creatinine or urine output criteria on major adverse kidney events in cardiac surgery patients. J Thorac Cardiovasc Surg. 2021;162:143-151.
Mizota T, Yamamoto Y, Hamada M, Matsukawa S, Shimizu S, Kai S:Intraoperative oliguria predicts acute kidney injury after major abdominal surgery. Br J Anaesth. 2017;119:1127-1134.
Ariyarathna D, Bhonsle A, Nim J, et al. Intraoperative vasopressor use and early postoperative acute kidney injury in elderly patients undergoing elective non-cardiac surgery. Ren Fail. 2022;44(1):648-659.
Cavallaro P, Bordeianou L. Implementation of an ERAS pathway in colorectal surgery. Clin Colon Rectal Surg. 2019;32(2):102-108.
Myles PS, Bellomo R, McCluskey S, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. New Engl J Med. 2018;378:2263-2274.
Shen W, Wu Z, Wang Y, Sun Y, Wu A. Impact of enhanced recovery after surgery (ERAS) protocol versus standard of care on postoperative acute kidney injury (AKI): a meta-analysis. PLoS One. 2021;16(5):e0251476.
Biteker M, Dayan A, Tekkesin AI, et al. Incidence, risk factors, and outcomes of perioperative acute kidney injury in non-cardiac and nonvascular surgery. Am J Surg. 2014;207:53-59.
Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery:results from a national data set. Anesthesiology. 2009;110:505-515.
Kim M, Brady JE, Li G. Variations in the risk of acute kidney injury across intraabdominal surgery procedures. Anesth Analg. 2014;119:1121-1132.