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

Meersch, M.; Weiss, R.; Strauss, C.; Albert, F.; Booke, H.; Forni, L.; Pittet, J.; Kellum, J. A.; Rosner, M.; Mehta, R.; Bellomo, R.; Rosenberger, P.; Zarbock, A.; Makhloufi, H.; Sakhraoui, R.; Ouyahia, A.; Rais, M.; Kouicem, A. T.; Derwish, K.; Abdoun, M.; Ouahab, I.; Bouaoud, S.; Tidjane, A.; Perez Rivera, C. J.; Garcia, J. P.; Peng, K.; F. -H., Ji; Z. -M., Ma; Elbahnasawy, M. G.; Elsalhawy, S.; Nafea, A. M.; Osman, N. A.; Emara, M. M.; Bonna, M. M.; Abdehaleem, I. A.; Abbas, A. M.; Abbas, M. S.; Esmaeil, H. M.; Joannes-Boyau, O.; Legros, V.; Floch, T.; Muccio, S.; Menage-Innocenti, L.; Brochet, B.; Leclercq-Rouget, M.; Geneve, C.; Mocarquer, B. V.; Aveline, C.; Vautier, P.; Nadaud, J.; Rimmele, T.; Cerro, V.; Suria, S.; Elmawieh, J.; El-Jawiche, R.; Cirenei, C.; Lebuffe, G.; Ponsonnard, S.; Egreteau, P. -Y.; Ichai, C.; Jean-Michel, V.; Leger, M.; Lasocki, S.; Masson, C.; Rineau, E.; Cassisa, V.; Verrier, P.; Atchade, E.; Rochon, C. -E.; Quentin, V.; Queixalos, N.; Braun, T.; Grand, H.; Mayeur, N.; Pasquie, M.; Garcon, P.; Bruckert, V.; Pradel, G.; Ramorasata, A.; Ravry, C.; Mottard, N.; von Groote, T.; Dorr, C.; Kullmar, M.; Massoth, C.; Motekallemi, A.; Saadat-Gilani, K.; Kerschke, L.; Storck, M.; Varghese, J.; Wempe, C.; Grusser, L.; Kowark, A.; Brandenburger, T.; Hohn, A.; Haberle, H.; Hofmann, P.; Kuhle, J.; Calov, S.; Bernard, A. M.; Mirakaj, V.; Weber, K.; Pfister, K.; Stetz, L.; Muller, S. D.; Klaus, S.; Sadlo, M.; Sengelhoff, C.; Stenger, C. -K.; Gobel, U.; Heringlake, M.; Arnaoutoglou, E.; Stratigopoulou, P.; Danai, P.; Dimakopoulou, A.; Menis, A. -A.; Ioannidis, O.; Jalaawiy, H.; Anwar, A.; Hashim, H. T.; Rasheed Aldawoody, H. I.; Cortegiani, A.; Ippolito, M.; Marino, C.; Presti, G.; Fricano, D. C.; De Rosa, S.; Bianchin, A.; Paternoster, G.; Fasciano, U.; Cutuli, S. L.; Savino, S.; Enrico, B.; Marco, P.; Alberto, V. C.; Tripodi, V. F.; Fiume, D.; Iuorio, A.; Santorsola, C.; Abu-Hussein, B.; Hasanein, K.; Shin, S.; Baek, J.; Kim, S.; Elhadi, M.; Aldressi, W.; Abuzeid, I. A.; Albaraesi, M. N.; Moftah, M. A.; Aldressi, S.; Khalel, W.; Abdulwahed, E.; Ali Alshareea, E. A.; Abujrad Reem Ghmagh, A. A. A.; Biala, M. I.; Benjouira, R. A. I.; Aliwa, M.; Msherghi, A.; Tuwaib, A.; Mustafa, T.; Zriba, H.; Agilla, H. M.; Sadek Ben Hamida, B. T.; Mohamed Otman, R. H.; Mijovska, M. M.; Podesta, A. M. C.; Gasca Lopez, G. A.; Amro, S.; de Freitas Regufe, R.; Grigoryev, E.; Ivkin, A.; Balakhnin, D.; Shukevich, D.; Yaroustovsky, M.; Barmou, A.; Kaserer, A.; Castellucci, C.; Akbas, S.; Petrun, A. M.; Gregorcic, I.; Sok, V.; Links, A.; Barreto, E. B.; Melchor, J. R.; Becerra-Bolanos, A.; Rodriguez-Perez, A.; Estevez, J. M.; Matas, J. M.; Palao, S. P.; Alvarez, M. G.; Albadalejo, A. B.; Gonzalez, A. B.; Caro, A. M. G.; Blanco, I. H.; Fernandez, D. T.; Perez, G. H.; Ejea, M. L.; de la Rosa Ruiz, N.; Abasolo, M. G.; Ferreira, L.; Lobato, F.; Sevilla, M. A.; Erazo, A.; Paulis, B. C.; de la Calle Gil, I.; Adamove, P.; Blasco, F. M. B.; Garcia-Sanchez, J. I.; Zamorano, S. G.; Herreros, N. G.; Callejas, R.; Gomez, M. E.; Candela-Toha, A. M.; Claros-Llamas, E.; Cobeta-Orduna, P.; Crespo-Aliseda, P.; Dorado-Diaz, T.; Gomez-Rojo, M.; Mane-Ruiz, M. N.; Gonzalez, M. C. M.; Martinez-Perez, A.; Tiscar, C.; Menendez, P. G.; Calvo, V. E.; Espi, L. L.; Aldean, Y. S. L.; Ariza, V. M.; Vila, L. V.; Garcia-Miguel, F. J.; Suliman, E. S. M.; Ibrahim, A. M.; Fadlalmola, H. A.; Swed, S.; V. -C., Wu; Orhan-Sungur, M.; Altun, D.; Canbolat, N.; Dincer, M. B.; Yildirim, S. A.; Iyigun, M.; Yapici, D.; Ozdemir, L.; Sagun, A.; Boztug, N.; Gunduz, E.; Lafli-Tunay, D.; Karakaya, D.; Dost, B.; Komurcu, O.; Dilmen, O. K.; Akcil, E. F.; Tunali, Y.; Ok, G.; Tok-Alsina, E.; Polat, C.; Kizilcik, N.; Sen, O.; Darcin, K.; Ugur, S.; Gurkan, Y.; Saracoglu, K. T.; Yildiz-Koyuncu, O.; Demir, Z. A.; Postaci, N. A.; Ozgok, A.; Karadeniz, U.; Ozay, H. Y.; Balci, E.; Salman, N.; Girgin, B.; Sagir, O.; Demir, H. F.; Ugun, F.; Toprak, H. I.; Ozcan, M. S.; Alkaya-Solmaz, F.; Yilmaz, M.; Karaca, U.; Sahin, S. H.; Erkoc, S. K.; Alkis, N.; Baytas, V.; Erturk, E.; Saylan, S.; Akdogan, A.; Yesil, B. B.; Boran, O. F.; Orak, Y.; Calisir, F.; Buyukcoban, S.; Kuvaki, B.; Cansabuncu, S.; Akesen, S.; Goren, S.; Yeniocak, T.; Orman, O.; Karka, O. E.; Sahin, T.; Momot, N.; Panchenko, A.; Pittet, J. -F.; Rutledge, K.

doi:10.1007/s00134-023-07314-2

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.

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

Meersch M.;Weiss R.;Strauss C.;Albert F.;Booke H.;Forni L.;Pittet J.;Kellum J. A.;Rosner M.;Mehta R.;Bellomo R.;Rosenberger P.;Zarbock A.;Makhloufi H.;Sakhraoui R.;Ouyahia A.;Rais M.;Kouicem A. T.;Derwish K.;Abdoun M.;Ouahab I.;Bouaoud S.;Tidjane A.;Perez Rivera C. J.;Garcia J. P.;Peng K.;Ji F. -H.;Ma Z. -M.;Elbahnasawy M. G.;Elsalhawy S.;Nafea A. M.;Osman N. A.;Emara M. M.;Bonna M. M.;Abdehaleem I. A.;Abbas A. M.;Abbas M. S.;Esmaeil H. M.;Joannes-Boyau O.;Legros V.;Floch T.;Muccio S.;Menage-Innocenti L.;Brochet B.;Leclercq-Rouget M.;Geneve C.;Mocarquer B. V.;Aveline C.;Vautier P.;Nadaud J.;Rimmele T.;Cerro V.;Suria S.;Elmawieh J.;El-Jawiche R.;Cirenei C.;Lebuffe G.;Ponsonnard S.;Egreteau P. -Y.;Ichai C.;Jean-Michel V.;Leger M.;Lasocki S.;Masson C.;Rineau E.;Cassisa V.;Verrier P.;Atchade E.;Rochon C. -E.;Quentin V.;Queixalos N.;Braun T.;Grand H.;Mayeur N.;Pasquie M.;Garcon P.;Bruckert V.;Pradel G.;Ramorasata A.;Ravry C.;Mottard N.;von Groote T.;Dorr C.;Kullmar M.;Massoth C.;Motekallemi A.;Saadat-Gilani K.;Kerschke L.;Storck M.;Varghese J.;Wempe C.;Grusser L.;Kowark A.;Brandenburger T.;Hohn A.;Haberle H.;Hofmann P.;Kuhle J.;Calov S.;Bernard A. M.;Mirakaj V.;Weber K.;Pfister K.;Stetz L.;Muller S. D.;Klaus S.;Sadlo M.;Sengelhoff C.;Stenger C. -K.;Gobel U.;Heringlake M.;Arnaoutoglou E.;Stratigopoulou P.;Danai P.;Dimakopoulou A.;Menis A. -A.;Ioannidis O.;Jalaawiy H.;Anwar A.;Hashim H. T.;Rasheed Aldawoody H. I.;Cortegiani A.;Ippolito M.;Marino C.;Presti G.;Fricano D. C.;De Rosa S.;Bianchin A.;Paternoster G.;Fasciano U.;Cutuli S. L.;Savino S.;Enrico B.;Marco P.;Alberto V. C.;Tripodi V. F.;Fiume D.;Iuorio A.;Santorsola C.;Abu-Hussein B.;Hasanein K.;Shin S.;Baek J.;Kim S.;Elhadi M.;Aldressi W.;Abuzeid I. A.;Albaraesi M. N.;Moftah M. A.;Aldressi S.;Khalel W.;Abdulwahed E.;Ali Alshareea E. A.;Abujrad Reem Ghmagh A. A. A.;Biala M. I.;Benjouira R. A. I.;Aliwa M.;Msherghi A.;Tuwaib A.;Mustafa T.;Zriba H.;Agilla H. M.;Sadek Ben Hamida B. T.;Mohamed Otman R. H.;Mijovska M. M.;Podesta A. M. C.;Gasca Lopez G. A.;Amro S.;de Freitas Regufe R.;Grigoryev E.;Ivkin A.;Balakhnin D.;Shukevich D.;Yaroustovsky M.;Barmou A.;Kaserer A.;Castellucci C.;Akbas S.;Petrun A. M.;Gregorcic I.;Sok V.;Links A.;Barreto E. B.;Melchor J. R.;Becerra-Bolanos A.;Rodriguez-Perez A.;Estevez J. M.;Matas J. M.;Palao S. P.;Alvarez M. G.;Albadalejo A. B.;Gonzalez A. B.;Caro A. M. G.;Blanco I. H.;Fernandez D. T.;Perez G. H.;Ejea M. L.;de la Rosa Ruiz N.;Abasolo M. G.;Ferreira L.;Lobato F.;Sevilla M. A.;Erazo A.;Paulis B. C.;de la Calle Gil I.;Adamove P.;Blasco F. M. B.;Garcia-Sanchez J. I.;Zamorano S. G.;Herreros N. G.;Callejas R.;Gomez M. E.;Candela-Toha A. M.;Claros-Llamas E.;Cobeta-Orduna P.;Crespo-Aliseda P.;Dorado-Diaz T.;Gomez-Rojo M.;Mane-Ruiz M. N.;Gonzalez M. C. M.;Martinez-Perez A.;Tiscar C.;Menendez P. G.;Calvo V. E.;Espi L. L.;Aldean Y. S. L.;Ariza V. M.;Vila L. V.;Garcia-Miguel F. J.;Suliman E. S. M.;Ibrahim A. M.;Fadlalmola H. A.;Swed S.;Wu V. -C.;Orhan-Sungur M.;Altun D.;Canbolat N.;Dincer M. B.;Yildirim S. A.;Iyigun M.;Yapici D.;Ozdemir L.;Sagun A.;Boztug N.;Gunduz E.;Lafli-Tunay D.;Karakaya D.;Dost B.;Komurcu O.;Dilmen O. K.;Akcil E. F.;Tunali Y.;Ok G.;Tok-Alsina E.;Polat C.;Kizilcik N.;Sen O.;Darcin K.;Ugur S.;Gurkan Y.;Saracoglu K. T.;Yildiz-Koyuncu O.;Demir Z. A.;Postaci N. A.;Ozgok A.;Karadeniz U.;Ozay H. Y.;Balci E.;Salman N.;Girgin B.;Sagir O.;Demir H. F.;Ugun F.;Toprak H. I.;Ozcan M. S.;Alkaya-Solmaz F.;Yilmaz M.;Karaca U.;Sahin S. H.;Erkoc S. K.;Alkis N.;Baytas V.;Erturk E.;Saylan S.;Akdogan A.;Yesil B. B.;Boran O. F.;Orak Y.;Calisir F.;Buyukcoban S.;Kuvaki B.;Cansabuncu S.;Akesen S.;Goren S.;Yeniocak T.;Orman O.;Karka O. E.;Sahin T.;Momot N.;Panchenko A.;Pittet J. -F.;Rutledge K.

2024-01-01

Abstract

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.

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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11563/190523

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

2024-01-01

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