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

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2024年1月29日

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Melanie Meersch,
Raphael Weiss,
Christian Strauß,
Felix Albert,
Hendrik Booke,
Lui Forni,
Jean-Francois Pittet,
John A. Kellum,
Mitchell Rosner,
Ravindra Mehta,
Rinaldo Bellomo,
Peter Rosenberger,
Alexander Zarbock,
Hichem Makhloufi,
Rachida Sakhraoui,
Amel Ouyahia,
Mounira Rais,
Aya Tinhinane Kouicem,
Khawla Derwish,
Meriem Abdoun,
Ilhem Ouahab,
Souad Bouaoud,
Anisse Tidjane,
Carlos Jose Pérez Rivera,
Juan Pablo García,
Ke Peng,
Fu-hai Ji,
Zheng-min Ma,
Mohamed Gamal Elbahnasawy,
Shady Elsalhawy,
Ahmed Mahmoud Nafea,
Nermin A. Osman,
Moataz Maher Emara,
Mohamed Mamdouh Bonna,
Ibrahim Abdelmonaem Abdehaleem,
Ahmed Mohamed Abbas,
Mostafa Samy Abbas,
Hany Mostafa Esmaeil,
Oliver Joannes-Boyau,
Vincent Legros,
Thierry Floch,
Salvatore Muccio,
Lison Menage-Innocenti,
Benjamin Brochet,
Marion Leclercq-Rouget,
Claire Geneve,
Bernardita Valenzuela Mocarquer,
Christophe Aveline,
Pierre Vautier,
Julien Nadaud,
Thomas Rimmelé,
Valérie Cerro,
Stéphanie Suria,
Jamie Elmawieh,
Rita El-Jawiche,
Cédric Cirenei,
Gilles Lebuffe,
Sébastien Ponsonnard,
Pierre-Yves Egreteau,
Carole Ichai,
Vanessa Jean-Michel,
Maxime Léger,
Sigismond Lasocki,
Charline Masson,
Emmanuel Rineau,
Viviane Cassisa,
Pierre Verrier,
Enora Atchade,
Charles-Edouard Rochon,
Vidal Quentin,
Nina Queixalos,
Thierry Braun,
Hubert Grand,
Nicolas Mayeur,
Marie Pasquie,
Pierre Garçon,
Vincent Bruckert,
Gaël Pradel,
Andersen Ramorasata,
Céline Ravry,
Nicolas Mottard,
Alexander Zarbock,
Melanie Meersch,
Raphael Weiss,
Thilo von Groote,
Christian Dörr,
Mira Küllmar,
Christina Massoth,
Arash Motekallemi,
Khaschayar Saadat-Gilani,
Felix Albert,
Laura Kerschke,
Michael Storck,
Julian Varghese,
Carola Wempe,
Linda Grüßer,
Ana Kowark,
Timo Brandenburger,
Andreas Hohn,
Peter Rosenberger,
Helene Häberle,
Pascal Hofmann,
Jonathan Kuhle,
Stefanie Calov,
Alice Marie Bernard,
Valbona Mirakaj,
Kathrin Weber,
Kathrin Pfister,
Lena Stetz,
Sarah Dorothea Müller,
Stephan Klaus,
Marco Sadlo,
Christian Sengelhoff,
Carina-Kristin Stenger,
Ulrich Göbel,
Matthias Heringlake,
Eleni Arnaoutoglou,
Panagiota Stratigopoulou,
Pantazi Danai,
Antonia Dimakopoulou,
Apostolos-Alkiviadis Menis,
Orestis Ioannidis,
Humam Jalaawiy,
Aeshah Anwar,
Hashim Talib Hashim,
Hogir Imad Rasheed Aldawoody,
Andrea Cortegiani,
Mariachiara Ippolito,
Claudia Marino,
Gabriele Presti,
Dario Calogero Fricano,
Silvia De Rosa,
Andrea Bianchin,
Gianluca Paternoster,
Umberto Fasciano,
Salvatore Lucio Cutuli,
Spadaro Savino,
Bussolati Enrico,
Palmieri Marco,
Volta Carlo Alberto,
Vincenzo Francesco Tripodi,
Diego Fiume,
Angela Iuorio,
Clemente Santorsola,
Bilal Abu-Hussein,
Khaled Hasanein,
Seokyung Shin,
Jongyoon Baek,
Sehui Kim,
Muhammed Elhadi,
Wafa Aldressi,
Issa A. Abuzeid,
Mohammed N. Albaraesi,
Mohamed Aziz Moftah,
Sarah Aldressi,
Wegdan Khalel,
Eman Abdulwahed,
Entisar Ahmed Ali Alshareea,
Akram Abdulhamid Ashur Abujrad,
Reem Ghmagh,
Marwa Isa Biala,
Khawla Derwish,
Rayet Al Islam Benjouira,
Mohamed Aliwa,
Ahmed Msherghi,
Ahmed Tuwaib,
Tahani Mustafa,
Haifa Zriba,
Hamza Mahmoud Agilla,
Bahaeddin Taher Sadek Ben Hamida,
Rema Hassan Mohamed Otman,
Maja Mojsova Mijovska,
Anne Marie Camilleri Podesta,
Gilberto Adrián Gasca López,
Sarah Amro,
Rita de Freitas Regufe,
Evgeny Grigoryev,
Artem Ivkin,
Dmitriy Balakhnin,
Dmitriy Shukevich,
Michael Yaroustovsky,
Abdulnaser Barmou,
Alexander Kaserer,
Clara Castellucci,
Samira Akbas,
Andreja Möller Petrun,
Irena Gregorcic,
Vesna Sok,
Andre Links,
Elizabeth Bárcena Barreto,
Javier Ripollés Melchor,
Ángel Becerra-Bolaños,
Aurelio Rodríguez-Pérez,
Javier Mata Estévez,
Juan Mulet Matas,
Sara Pérez Palao,
Mercedes García Álvarez,
Albert Bainac Albadalejo,
Astrid Batalla González,
Ana María Gómez Caro,
Ignacio Hinojal Blanco,
Diego Toral Fernandez,
Gracia Herranz Perez,
Margarita Logroño Ejea,
Noelia de la Rosa Ruiz,
María Gastaca Abasolo,
Lourdes Ferreira,
Félix Lobato,
Marta Aguado Sevilla,
Andres Erazo,
Berta Castellano Paulis,
Isabel de la Calle Gil,
Peter Adamove,
Francho Miguel Blasco Blasco,
Jose Ignacio García-Sánchez,
Sara García Zamorano,
Natalia Gijón Herreros,
Raquel Callejas,
Mercedes Estaire Gómez,
Angel M. Candela-Toha,
Elisabeth Claros-Llamas,
Pilar Cobeta-Orduña,
Pascual Crespo-Aliseda,
Trinidad Dorado-Díaz,
María Gómez-Rojo,
M. Nuria Mané-Ruiz,
M. Carmen Martín-González,
Adolfo Martínez-Pérez,
Carlos Tiscar,
Patricia Galán Menéndez,
Verónica Estepa Calvo,
Laura Llinares Espí,
Yuri Santiago Loaiza Aldeán,
Víctor Morales Ariza,
Laura Villarino Vila,
Francisco Javier García-Miguel,
Elfayadh S. M. Suliman,
Ahmed Mohamed Ibrahim,
Hammad Ali. Fadlalmola,
Sarya Swed,
Vin-Cent Wu,
Mukadder Orhan-Sungur,
Demet Altun,
Nur Canbolat,
Müşerref Beril Dinçer,
Serap Aktas Yildirim,
Muzeyyen Iyigun,
Davud Yapıcı,
Levent Özdemir,
Aslınur Sagün,
Neval Boztug,
Emel Gündüz,
Demet Lafli-Tunay,
Deniz Karakaya,
Burhan Dost,
Ozgur Komurcu,
Ozlem Korkmaz Dilmen,
Eren Fatma Akcil,
Yusuf Tunali,
Gulay Ok,
Eda Tok-Alsina,
Cengiz Polat,
Nurcan Kızılcık,
Öznur Şen,
Kamil Darçın,
Semra Uğur,
Yavuz Gürkan,
Kemal Tolga Saracoglu,
Özge Yıldız-Koyuncu,
Z. Aslı Demir,
N. Aysun Postacı,
Ayşegül Özgök,
Ümit Karadeniz,
Hülya Yiğit Özay,
Eda Balcı,
Nevriye Salman,
Behiç Girgin,
Ozlem Sagir,
Hafize Fisun Demir,
Fatih Ugun,
Hüseyin İlksen Toprak,
Mustafa Soner Özcan,
Filiz Alkaya-Solmaz,
Mehmet Yilmaz,
Umran Karaca,
Sevtap Hekimoglu Şahin,
Süheyla Karadağ Erkoç,
Neslihan Alkış,
Volkan Baytaş,
Engin Erturk,
Sedat Saylan,
Ali Akdogan,
Beyza Büyükgebiz Yeşil,
Omer Faruk Boran,
Yavuz Orak,
Feyza Çalişir,
Sibel Büyükçoban,
Bahar Kuvaki,
Seda Cansabuncu,
Selcan Akesen,
Suna Gören,
Tugce Yeniocak,
Osman Orman,
Özlem Ersoy Karka,
Tulay Sahin,
Natalia Momot,
Anna Panchenko,
Jean-Francois Pittet,
Kristen Rutledge

摘要

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.