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Lei SH, Guo GF, Yan T, Zhao BC, Qiu SD, Liu KX. Acute Kidney Injury After General Thoracic Surgery: A Systematic Review and Meta-Analysis. J Surg Res 2023; 287:72-81. [PMID: 36870304 DOI: 10.1016/j.jss.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/28/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The clinical importance of postoperative acute kidney injury (AKI) in patients undergoing general thoracic surgery is unclear. We aimed to systematically review the incidence, risk factors, and prognostic implications of AKI as a complication after general thoracic surgery. METHODS We searched PubMed, EMBASE, and the Cochrane Library from January 2004 to September 2021. Observational or interventional studies that enrolled ≥50 patients undergoing general thoracic surgery and reported postoperative AKI defined using contemporary consensus criteria were included for meta-analysis. RESULTS Thirty-seven articles reporting 35 unique cohorts were eligible. In 29 studies that enrolled 58,140 consecutive patients, the pooled incidence of postoperative AKI was 8.0% (95% confidence interval [CI]: 6.2-10.0). The incidence was 3.8 (2.0-6.2) % after sublobar resection, 6.7 (4.1-9.9) % after lobectomy, 12.1 (8.1-16.6) % after bilobectomy/pneumonectomy, and 10.5 (5.6-16.7) % after esophagectomy. Considerable heterogeneity in reported incidences of AKI was observed across studies. Short-term mortality was higher (unadjusted risk ratio: 5.07, 95% CI: 2.99-8.60) and length of hospital stay was longer (weighted mean difference: 3.53, 95% CI: 2.56-4.49, d) in patients with postoperative AKI (11 studies, 28,480 patients). Several risk factors for AKI after thoracic surgery were identified. CONCLUSIONS AKI occurs frequently after general thoracic surgery and is associated with increased short-term mortality and length of hospital stay. For patients undergoing general thoracic surgery, AKI may be an important postoperative complication that needs early risk evaluation and mitigation.
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Affiliation(s)
- Shao-Hui Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gao-Feng Guo
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yan
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bing-Cheng Zhao
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Da Qiu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Córdova-Sánchez BM, Joffre-Torres A, Joachín-Sánchez E, Morales Buenrostro LE, Ñamendys-Silva SA. Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1-year mortality. Nephrology (Carlton) 2021; 26:965-971. [PMID: 34415095 DOI: 10.1111/nep.13964] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
AIM We aimed to identify risk factors associated with acute kidney injury (AKI) and to analyse 1-year mortality after oncological surgery. METHODS We retrospectively included 434 adult patients admitted to the intensive care unit (ICU) after oncological surgery, and classified AKI according to the Kidney Disease: Improving Global Outcomes criteria. We performed logistic regression and Cox regression analyses to evaluate AKI and mortality risk factors. RESULTS Sixty-one percent of patients (n = 264) developed AKI. Previous abdominal radiotherapy and abdominal surgical packing were independently associated with stage 2 and 3 AKI, with adjusted odds ratio (OR) of 2.6 (95% confidence interval [CI] 1.3-5.5, p = .010) and OR of 2.6 (95% CI 1.2-5.5, p = .014), respectively. Other independent risk factors were: glomerular filtration rate (eGFR) <60 ml/min/1.73m2 (OR 3.6, 95% CI 1.2-11.4, p = .028), abdominal surgery 2.6 (1.4-4.9, p = .003), intraoperative diuresis <1 ml/k/h (OR 2.4, 95% CI 1.4-4.0, p = .001), sepsis (OR 2.5, 95% CI 1.3-4.6, p = .002) and mechanical ventilation at ICU admission (OR 7.7, 95% CI 3.2-18.6, p < .001). Stage 2 and stage 3 AKI were independently associated with 1-year mortality, with adjusted hazard ratios (HR) of 2.6 (95% CI 1.3-5.0, p = .005) and HR of 5.0 (95% CI 2.6-9.6, p < .001), respectively. Additionally, patients who had postsurgical AKI, had a lower eGFR at 1-year follow-up. These findings may be limited by the retrospective single centre design of our study. CONCLUSION In addition to the conventional risk factors, our results suggest that abdominal radiotherapy and abdominal surgical packing could be independent risk factors for AKI after oncological surgery.
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Affiliation(s)
| | - Aranza Joffre-Torres
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Emerson Joachín-Sánchez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Silvio A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.,Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Mexico City, Mexico.,Society of Physicians of Medica Sur (Member), Mexico City, Mexico
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An Y, Shen K, Ye Y. Risk factors for and the prevention of acute kidney injury after abdominal surgery. Surg Today. 2018;48:573-583. [PMID: 29052006 DOI: 10.1007/s00595-017-1596-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022]
Abstract
Postoperative acute kidney injury in patients undergoing abdominal surgery is not rare and often results in bad outcomes for patients. The incidence of postoperative acute kidney injury is hard to evaluate reliably due to its non-unified definitions in different studies. Risk factors for acute kidney injury specific to abdominal surgery include preoperative renal insufficiency, intraabdominal hypertension, blood transfusion, bowel preparation, perioperative dehydration, contrast agent and nephrotoxic drug use. Among these, preoperative renal insufficiency is the strongest predictor of acute kidney injury. The peri-operative management of high-risk patients should include meticulous selection of fluid solutions. Balanced crystalloid solutions and albumin are generally thought to be relatively safe, while the safety of hydroxyethyl starch solutions has been controversial. The purpose of the present review is to discuss the current knowledge regarding postoperative acute kidney injury in abdominal surgical settings to help surgeons make better decisions concerning the peri-operative management.
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Abstract
OBJECTIVE Critically appraise prediction models for hospital-acquired acute kidney injury (HA-AKI) in general populations. DESIGN Systematic review. DATA SOURCES Medline, Embase and Web of Science until November 2016. ELIGIBILITY Studies describing development of a multivariable model for predicting HA-AKI in non-specialised adult hospital populations. Published guidance followed for data extraction reporting and appraisal. RESULTS 14 046 references were screened. Of 53 HA-AKI prediction models, 11 met inclusion criteria (general medicine and/or surgery populations, 474 478 patient episodes) and five externally validated. The most common predictors were age (n=9 models), diabetes (5), admission serum creatinine (SCr) (5), chronic kidney disease (CKD) (4), drugs (diuretics (4) and/or ACE inhibitors/angiotensin-receptor blockers (3)), bicarbonate and heart failure (4 models each). Heterogeneity was identified for outcome definition. Deficiencies in reporting included handling of predictors, missing data and sample size. Admission SCr was frequently taken to represent baseline renal function. Most models were considered at high risk of bias. Area under the receiver operating characteristic curves to predict HA-AKI ranged 0.71-0.80 in derivation (reported in 8/11 studies), 0.66-0.80 for internal validation studies (n=7) and 0.65-0.71 in five external validations. For calibration, the Hosmer-Lemeshow test or a calibration plot was provided in 4/11 derivations, 3/11 internal and 3/5 external validations. A minority of the models allow easy bedside calculation and potential electronic automation. No impact analysis studies were found. CONCLUSIONS AKI prediction models may help address shortcomings in risk assessment; however, in general hospital populations, few have external validation. Similar predictors reflect an elderly demographic with chronic comorbidities. Reporting deficiencies mirrors prediction research more broadly, with handling of SCr (baseline function and use as a predictor) a concern. Future research should focus on validation, exploration of electronic linkage and impact analysis. The latter could combine a prediction model with AKI alerting to address prevention and early recognition of evolving AKI.
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Affiliation(s)
- Luke Eliot Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Alexander Sarnowski
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Borislav D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Richard M Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - Lui G Forni
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Abstract
OBJECTIVES Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). DESIGN, SETTING AND PARTICIPANTS External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). METHODS Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. RESULTS HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). CONCLUSIONS On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate risk prediction.
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Affiliation(s)
- L E Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - B D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - P J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - R Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - L G Forni
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Abstract
Patients with cancer represent a growing group among actual ICU admissions (up to 20 %). Due to their increased susceptibility to infectious and noninfectious complications related to the underlying cancer itself or its treatment, these patients frequently develop acute kidney injury (AKI). A wide variety of definitions for AKI are still used in the cancer literature, despite existing guidelines on definitions and staging of AKI. Alternative diagnostic investigations such as Cystatin C and urinary biomarkers are discussed briefly. This review summarizes the literature between 2010 and 2015 on epidemiology and prognosis of AKI in this population. Overall, the causes of AKI in the setting of malignancy are similar to those in other clinical settings, including preexisting chronic kidney disease. In addition, nephrotoxicity induced by the anticancer treatments including the more recently introduced targeted therapies is increasingly observed. However, data are sometimes difficult to interpret because they are often presented from the oncological rather than from the nephrological point of view. Because the development of the acute tumor lysis syndrome is one of the major causes of AKI in patients with a high tumor burden or a high cell turnover, the diagnosis, risk factors, and preventive measures of the syndrome will be discussed. Finally, we will briefly discuss renal replacement therapy modalities and the emergence of chronic kidney disease in the growing subgroup of critically ill post-AKI survivors.
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Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Medicine, University Hospital, 185 De Pintelaan, 9000 Gent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Medicine, University Hospital, 185 De Pintelaan, 9000 Gent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Medicine, University Hospital, 185 De Pintelaan, 9000 Gent, Belgium
| | - Dominique Benoit
- Medical Intensive Care Unit, University Hospital, 185 De Pintelaan, 9000 Gent, Belgium
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Abstract
Postoperative increases in serum creatinine concentration, by amounts historically viewed as trivial, are associated with increased morbidity and mortality. Acute kidney injury is common, affecting one in five patients admitted with acute medical disease and up to four in five patients admitted to intensive care, of whom one in two have had operations. This review is focused principally on the identification of patients at risk of acute kidney injury and the prevention of injury. In the main, there are no interventions that directly treat the damaged kidney. The management of acute kidney injury is based on correction of dehydration, hypotension, and urinary tract obstruction, stopping nephrotoxic drugs, giving antibiotics for bacterial infection, and commencing renal replacement therapy if necessary.
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Affiliation(s)
- D Golden
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - J Corbett
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - L G Forni
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.,Surrey Peri-operative Anaesthesia and Critical Care Collaborative Research Group and Faculty of Health Care Sciences, University of Surrey, Guildford, Surrey, UK
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Alonso JV, cachinero PL, Ubeda FR, Ruiz DJL, Blanco A. Bilateral stones as a cause of acute renal failure in the emergency department. World J Emerg Med 2014; 5:67-71. [PMID: 25215151 PMCID: PMC4129866 DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 08/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute renal failure (ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive. METHODS We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy (SWL) for dissolution of calculi. RESULTS The patient was successfully treated, and reported asymptomatic in a follow-up. CONCLUSION Close collaboration between nephrological, urological, and radiological services is required.
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Affiliation(s)
- Joaquín V. Alonso
- Department of Emergency and Critical care Medicine, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Pedro L. cachinero
- Department of Emergency and Critical care Medicine, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Fran R. Ubeda
- Department of Emergency and Critical care Medicine, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Daniel J. L. Ruiz
- Department of Radiology, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Alfredo Blanco
- Department of Urology, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
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