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Guan HL, Liu H, Hu XY, Abdul M, Dai MS, Gao X, Chen XF, Zhou Y, Sun X, Zhou J, Li X, Zhao Q, Zhang QQ, Wang J, Han Y, Cao JL. Urinary albumin creatinine ratio associated with postoperative delirium in elderly patients undergoing elective non-cardiac surgery: A prospective observational study. CNS Neurosci Ther 2021; 28:521-530. [PMID: 34415671 PMCID: PMC8928921 DOI: 10.1111/cns.13717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction The blood‐brain barrier (BBB) disruption contributes to postoperative delirium, but cost‐effective and non‐invasive assessment of its permeability is not practicable in the clinical settings. Urine albumin to creatinine ratio (UACR), reflecting systemic vascular endothelial dysfunction, may be a prognostic and predictive factor associated with postoperative delirium. The aim was to analyze the relationship between UACR and postoperative delirium in elderly patients undergoing elective non‐cardiac surgery. Materials and methods Through stratified random sampling, a cohort of 408 individuals aged 60 years and older scheduled for elective non‐cardiac surgery were included between February and August 2019 in the single‐center, prospective, observational study. The presence of delirium was assessed using the Confusion Assessment Method (CAM) or Confusion Assessment Method for the ICU (CAM‐ICU) on the day of surgery, at 2 h after the surgery ending time and on the first 3 consecutive days with repeated twice‐daily, with at least 6‐h intervals between assessments. Urine samples were collected on one day before surgery, and 1st day and 3rd day after surgery. The primary outcome was the presence of postoperative delirium, and association of the level of UACR with postoperative delirium was evaluated with unadjusted/adjusted analyses and multivariable logistic regression. Results Postoperative delirium was observed in 26.75% (107 of 400) of patients within 3 days post‐surgery. UACR‐Pre (OR, 1.30; 95% CI, 1.14–1.49, p < 0.001), UACR‐POD1 (OR, 1.20; 95% CI, 1.13–1.27, p < 0.001), and UACR‐POD3 (OR, 1.14; 95% CI, 1.08–1.20, p < 0.001) between the delirium and non‐delirium groups show a significant difference, even after adjusting for age, education levels, and other factors. Conclusion As the marker of endothelial dysfunction, the high perioperative UACR value may be linked to the postoperative delirium in elderly patients undergoing elective non‐cardiac surgery.
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Affiliation(s)
- Hui-Lian Guan
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - He Liu
- Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou Central Hospital, Huzhou City, China
| | - Xiao-Yi Hu
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Mannan Abdul
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Ming-Sheng Dai
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Xing Gao
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Xue-Fen Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Zhou
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Xun Sun
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Jian Zhou
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Xiang Li
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Qiu Zhao
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Qian-Qian Zhang
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Jun Wang
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology & NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou City, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, China
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Chang CY, Chien YJ, Kao MC, Lin HY, Chen YL, Wu MY. Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:702-714. [PMID: 34101638 DOI: 10.1097/eja.0000000000001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. CONCLUSION Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. PROSPERO REGISTRATION CRD42020190065.
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Affiliation(s)
- Chun-Yu Chang
- From the Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (C-YC, M-CK, H-YL), Department of Anesthesiology, School of Medicine, Tzu Chi University, Hualien (C-YC, M-CK, H-YL), Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-JC), Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien (Y-JC), Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-LC, M-YW) and Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan (Y-LC, M-YW)
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Cagini L, Andolfi M, Potenza R, Ceccarelli S, Vannucci J, Berti V, Reboldi G, Puma F. Microalbuminuria assessment after thoracic surgery: Early identification of complication risks. Clin Respir J 2020; 14:564-570. [PMID: 32056371 DOI: 10.1111/crj.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Microalbuminuria (MA) is considered a reflection of systemic capillary leak and an early marker of acute stress reaction to the surgical insult, proportional to the severity of the initiating condition and predictive of the individual response to surgical stress. OBJECTIVES We conducted a prospective study to assess for the variation of MA within 4 days after thoracic surgery. We correlated observed MA levels with both their respective PaO2 /FiO2 respiratory ratio and the onset of postoperative complications. METHODS This single-centre study enrolled 255 consecutive patients having an American Society of Anaesthesiologists (ASA) score ≤ 3. The mean age was 62 years with 67% male. All patients were scheduled for elective pulmonary resection. MA was measured in urine samples as the albumin-to-creatinine ratio (A/C), prior to, at and after extubation up to 96 hours. PaO2 /FiO2 was measured at extubation and on the first postoperative day. RESULTS Overall, preoperative A/C levels resulted normal, with a significant average increase at extubation which peaked 6 hours later (P < 0.001). Larger postoperative A/C increases were observed in patients who developed postoperative complications, compared to those without these complications (P < 0.019). Moreover, patients undergoing major open pulmonary resections had larger postoperative A/C increases, compared to those undergoing minor video-assisted thoracic surgery resections (P < 0.006). At the time of extubation, A/C was inversely related to the PaO2 /FiO2 ratio (r = -0.25; P = 0.038). Peak A/C > 61 mg/g (P = 0.0003) was associated with postoperative cardio-pulmonary complications (OR 3.85; P = 0.003). CONCLUSION Within 6 hours after extubation, MA assessment may be a rapid and relatively inexpensive method for better predicting perioperative risk in an ASA score ≤ 3 population.
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Affiliation(s)
- Lucio Cagini
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.,Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Marco Andolfi
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.,Thoracic Surgery Unit, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Rossella Potenza
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Valeria Berti
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Thoracic Surgery Unit, Department of Surgical Science, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
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Marouli D, Stylianou K, Papadakis E, Kroustalakis N, Kolyvaki S, Papadopoulos G, Ioannou C, Papaioannou A, Daphnis E, Georgopoulos D, Askitopoulou H. Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery. J Clin Med 2018; 7:E431. [PMID: 30423970 DOI: 10.3390/jcm7110431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.
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George LK, Molnar MZ, Lu JL, Kalantar-Zadeh K, Koshy SKG, Kovesdy CP. Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting. Sci Rep 2015; 5:16458. [PMID: 26548590 PMCID: PMC4637927 DOI: 10.1038/srep16458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/09/2015] [Indexed: 11/18/2022] Open
Abstract
The effect on post-operative outcomes after coronary artery bypass graft(CABG) surgery is not clear. Among 17,812 patients who underwent CABG during October 1,2006-September 28,2012 in any Department of US Veterans Affairs(VA) hospital, we identified 5,968 with available preoperative urine albumin-creatinine ratio(UACR) measurements. We examined the association of UACR<30, 30–299 and >=300 mg/g with 30/90/180/365-day and overall all-cause mortality, and hospitalization length >10 days, and with acute kidney injury(AKI). Mean ± SD baseline age and eGFR were 66 ± 8 years and 77 ± 19 ml/min/1.73 m2, respectively. 788 patients(13.2%) died during a median follow-up of 3.2 years, and 26.8% patients developed AKI(23.1%-Stage 1; 2.9%-Stage 2; 0.8%-Stage 3) within 30 days of CABG. The median lengths of stay were 8 days(IQR: 6–13 days), 10 days(IQR: 7–14 days) and 12 days(IQR: 8–19 days) for groups with UACR < 30 mg/g, 30–299 mg/g and ≥300 mg/g, respectively. Higher UACR conferred 72 to 85% higher 90-, 180-, and 365-day mortality compared to UACR<30 mg/g (odds ratio and 95% confidence interval for UACR≥300 vs. <30 mg/g: 1.72(1.01–2.95); 1.85(1.14–3.01); 1.74(1.15–2.61), respectively). Higher UACR was also associated with significantly longer hospitalizations and higher incidence of all stages of AKI. Higher UACR is associated with significantly higher odds of mortality, longer post-CABG hospitalization, and higher AKI incidence.
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Affiliation(s)
- Lekha K George
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA.,Regional One Health, Memphis, 877 Jefferson Ave, Memphis, TN, 38103, USA
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Jun L Lu
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California, Irvine, 101 The City Drive, Orange, CA 92868, USA
| | - Santhosh K G Koshy
- Regional One Health, Memphis, 877 Jefferson Ave, Memphis, TN, 38103, USA.,Division of Cardiology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, 956 Court Ave, Memphis, TN, 38163, USA.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, 1030 Jefferson Ave., Memphis TN 38104, USA
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Hansen MK, Gammelager H, Mikkelsen MM, Hjortdal VE, Layton JB, Johnsen SP, Christiansen CF. Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study. Crit Care 2013; 17:R292. [PMID: 24330762 PMCID: PMC4057271 DOI: 10.1186/cc13158] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/27/2013] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI. METHODS We conducted a cohort study among adult elective cardiac surgical patients without severe chronic kidney disease and/or previous heart or renal transplant surgery using data from population-based registries. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria as a 50% increase in serum creatinine from baseline level, acute creatinine rise of ≥26.5 μmol/L (0.3 mg/dL) within 48 hours, and/or initiation of renal replacement therapy within five days after surgery. We followed patients from the fifth post-operative day until myocardial infarction, stroke or death within five years. Five-year risk was computed by the cumulative incidence method and compared with hazards ratios (HR) from a Cox proportional hazards regression model adjusting for propensity score. RESULTS A total of 287 (27.9%) of 1,030 patients developed AKI. Five-year risk of death was 26.5% (95% CI: 21.2 to 32.0) among patients with AKI and 12.1% (95% CI: 10.0 to 14.7) among patients without AKI. The corresponding adjusted HR of death was 1.6 (95% CI: 1.1 to 2.2). Five-year risk of myocardial infarction was 5.0% (95% CI: 2.9 to 8.1) among patients with AKI and 3.3% (95% CI: 2.1 to 4.8) among patients without AKI. Five-year risk of stroke was 5.0% (95% CI: 2.8 to 7.9) among patients with AKI and 4.2% (95% CI: 2.9 to 5.8) among patients without AKI. Adjusted HRs were 1.5 (95% CI: 0.7 to 3.2) of myocardial infarction and 0.9 (95% CI: 0.5 to 1.8) of stroke. CONCLUSIONS AKI, within five days after elective cardiac surgery, was associated with increased five-year mortality and a statistically insignificant increased risk of myocardial infarction. No association was seen with the risk of stroke.
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Affiliation(s)
- Malene Kærslund Hansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Henrik Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Martin Majlund Mikkelsen
- Department of Dermato- and Venerolgy, Aarhus University Hospital, P.P. Ørums Gade 11, 8000 Aarhus C, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - J Bradley Layton
- Department of Epidemiology, University of North Carolina at Chapel Hill, 2106 McGavran-Greenberg Hall CB 7435, Chapel Hill, NC 27599-7435, USA
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, 8200 Aarhus N, Denmark
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Haase M, Story DA, Haase-Fielitz A. Renal injury in the elderly: Diagnosis, biomarkers and prevention. Best Pract Res Clin Anaesthesiol 2011; 25:401-12. [DOI: 10.1016/j.bpa.2011.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/16/2011] [Indexed: 12/27/2022]
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