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Lydon K, Shah S, Mongan KL, Mongan PD, Cantrell MC, Awad Z. Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:39. [PMID: 38956707 PMCID: PMC11218130 DOI: 10.1186/s44158-024-00176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery. METHODS This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018-December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes. RESULTS AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI Risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8-35.1) and the AKI Risk score (OR = 6.3, 95% C.I. 2.4-16.4) were associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality. CONCLUSION In this analysis, intraoperative volume administration, vasopressor therapy, and a blood pressure < 55 mmHg for more than 10 min were not associated with an increased risk of AKI. After multivariate analysis, male gender and an elevated AKI Risk score were associated with an increased likelihood of AKI.
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Affiliation(s)
- Kerri Lydon
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Saurin Shah
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Kai L Mongan
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Paul D Mongan
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA.
| | | | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
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2
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Li S, Ren W, Ye X, Zhang L, Song B, Guo Z, Bian Q. An online-predictive model of acute kidney injury after pancreatic surgery. Am J Surg 2024; 228:151-158. [PMID: 37716826 DOI: 10.1016/j.amjsurg.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE Acute kidney injury(AKI) after pancreatic surgery is associated with increased mortality, longer hospital stays and poor prognosis. This study aims to identify the risk factors and establish an easy-to-use prediction calculator by the nomogram to predict the risk of AKI after pancreatic surgery. METHODS From January 2016 to June 2018, 1504 patients who underwent pancreatic surgery in our center were included in this retrospective analysis and randomly assigned to primary (1054 patients) and validation (450 patients) cohorts. The independent risk factors of AKI were identified using univariate and multivariate analyses. A risk-predicted nomogram for AKI was developed through multivariate logistic regression analysis in the primary cohort while the nomogram was evaluated in the validation cohort. Nomogram discrimination and calibration were assessed using C-index and calibration curves in the primary and validation cohorts. The clinical utility of the final nomogram was evaluated using decision curve analysis. RESULTS The overall incidence of AKI after pancreatic surgery was 5.3% (79/1504). Independent risk factors including smoking history, cardiovascular disease, ASA score, baseline eGFR, bilirubin>2 mg/dL, undergoing pancreaticoduodenectomy, and intraoperative blood loss>400 mL were identified by multivariate analysis. Nomogram revealed moderate discrimination and calibration in estimating the risk of AKI, with an unadjusted C-index of 0.79 (95 %CI, 0.73-0.85). Application of the nomogram in the validation cohort provided moderate discrimination (C-index,0.80 [95% CI, 0.72-0.88]) and good calibration. Besides, the decision curve analysis (DCA) confirmed the clinical usefulness of the nomogram. CONCLUSIONS An easy-to-use online prediction calculator comprised of preoperative and intraoperative factors was able to individually predict the occurrence risk of AKI among patients with pancreatic surgery, which may help identify reasonable risk judgments and develop proper treatment strategies to a certain extent.
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Affiliation(s)
- Siqian Li
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Weifu Ren
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Linyan Zhang
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Bin Song
- Department of Hepatopancreatobiliary Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhiyong Guo
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Qi Bian
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
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Ratnaningrum A, Taufik MA, Irawany V, Sedono R. Early continuous renal replacement therapy for postoperative patient with acute kidney injury following total pancreato-splenectomy: a case report. J Med Case Rep 2023; 17:201. [PMID: 37194096 DOI: 10.1186/s13256-023-03923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Acute kidney injury is a devastating postoperative complication. Renal replacement therapy is a treatment modality for acute kidney injury. Continuous renal replacement therapy is the treatment of choice for patients with hemodynamic instability. The main question in the management of acute kidney injury is when to initiate the renal replacement therapy. Several studies have demonstrated improvement in patients with septic acute kidney injury, following early continuous renal replacement therapy. To date, no guidelines have been established on the perfect timing to initiate continuous renal replacement therapy. In this case report, we did an early continuous renal replacement therapy as an extracorporeal therapy for blood purification and renal support. CASE PRESENTATION Our patient was a 46-year-old male of Malay ethnicity, undergoing total pancreatectomy due to a duodenal tumor. The preoperative assessment showed that the patient was high risk. Intraoperatively, massive surgical bleeding was sustained due to extensive tumor resection; thus, massive blood product transfusion was necessary. After the surgery, the patient suffered from postoperative acute kidney injury. We performed early continuous renal replacement therapy, within 24 hours after the diagnosis of acute kidney injury. Upon completion of continuous renal replacement therapy, the patient's condition improved, and he was discharged from the intensive care unit on the sixth postoperative day. CONCLUSION The timing for the initiation of renal replacement therapy remains controversial. It is clear that the "conventional criteria" for initiating renal replacement therapy need correction. We found that early continuous renal replacement therapy initiated in less than 24 hour after the postoperative acute kidney injury diagnosis gave our patient survival benefit.
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Affiliation(s)
- Apriliana Ratnaningrum
- Trainee of Department of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - M Azhari Taufik
- Department of Anesthesiology and Intensive Care, Fatmawati Center General Hospital, Jakarta, Indonesia
| | - Vera Irawany
- Department of Anesthesiology and Intensive Care, Fatmawati Center General Hospital, Jakarta, Indonesia
| | - Rudyanto Sedono
- Department of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Swartling O, Evans M, Larsson P, Gilg S, Holmberg M, Klevebro F, Löhr M, Sparrelid E, Ghorbani P. Risk factors for acute kidney injury after pancreatoduodenectomy, and association with postoperative complications and death. Pancreatology 2023; 23:227-233. [PMID: 36639282 DOI: 10.1016/j.pan.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with increased morbidity and mortality after general surgery, although little is known among patients undergoing pancreatoduodenectomy. The objective was to investigate the association between AKI and postoperative complications and death after pancreatoduodenectomy. METHODS All patients ≥18 years who underwent a pancreatoduodenectomy 2008-2019 at the Karolinska University Hospital, Stockholm, Sweden, were included. Standardized criteria for AKI, including estimated glomerular filtration rate (eGFR) and urine volume measurements, were used to grade postoperative AKI. RESULTS In total, 970 patients were included with a median age of 68 years (IQR 61-74) of whom 517 (53.3%) were men. There were 137 (14.1%) patients who developed postoperative AKI. Risk factors for AKI included lower preoperative eGFR, cardiovascular disease and treatment with renin-angiotensin system inhibitors or diuretics. Those who developed AKI had a higher risk of severe postoperative complications, including Clavien-Dindo score ≥ IIIa (adjusted OR 3.35, 95% CI 2.24-5.01) and ICU admission (adjusted OR 7.83, 95% CI 4.39-13.99). In time-to-event analysis, AKI was associated with an increased risk for both 30-day mortality (adjusted HR 4.51, 95% CI 1.54-13.27) and 90-day mortality (adjusted HR 4.93, 95% CI 2.37-10.26). Patients with benign histology and AKI also had an increased 1-year mortality (HR 4.89, 95% CI 1.88-12.71). CONCLUSIONS Postoperative AKI was associated with major postoperative complications and an increased risk of postoperative mortality. Monitoring changes in serum creatinine levels and urine volume output could be important in the immediate perioperative period to improve outcomes after pancreatoduodenectomy.
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Affiliation(s)
- Oskar Swartling
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Evans
- Renal Unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Larsson
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Klevebro
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias Löhr
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis. J Anesth 2022; 37:219-233. [PMID: 36520229 DOI: 10.1007/s00540-022-03150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the association between intraoperative oliguria and the risk of postoperative acute kidney injury (AKI) in patients undergoing non-cardiac surgery. METHODS The MEDLINE and EMBASE databases were searched up to August 2022 for studies in adult patients undergoing non-cardiac surgery, where the association between intraoperative urine output and the risk of postoperative AKI was assessed. Both randomised and non-randomised studies were eligible for inclusion. Study selection and risk of bias assessment were independently performed by two investigators. The risk of bias was evaluated using the Newcastle-Ottawa scale. We performed meta-analysis of the reported multivariate adjusted odds ratios for the association between intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the risk of postoperative AKI using the inverse-variance method with random effects models. We conducted sensitivity analyses using varying definitions of oliguria as well as by pooling unadjusted odds ratios to establish the robustness of the primary meta-analysis. We also conducted subgroup analyses according to surgery type and definition of AKI to explore potential sources of clinical or methodological heterogeneity. RESULTS Eleven studies (total 49,252 patients from 11 observational studies including a post hoc analysis of a randomised controlled trial) met the selection criteria. Seven of these studies contributed data from a total 17,148 patients to the primary meta-analysis. Intraoperative oliguria was associated with a significantly elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.36-2.23, p < 0.0001, 8 studies). Sensitivity analyses supported the robustness of the primary meta-analysis. There was no evidence of any significant subgroup differences according to surgery type or definition of AKI. CONCLUSIONS This study demonstrated a significant association between intraoperative oliguria and the risk of postoperative AKI, regardless of the definitions of oliguria or AKI used. Further prospective and multi-centre studies using standardised definitions of intraoperative oliguria are required to define the thresholds of oliguria and establish strategies to minimise the risk of AKI.
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Jacquemin M, Mokart D, Faucher M, Ewald J, Tourret M, Brun C, Tezier M, Mallet D, Nguyen Duong L, Cambon S, Pouliquen C, Ettori F, Sannini A, Gonzalez F, Bisbal M, Chow-Chine L, Servan L, de Guibert JM, Boher JM, Turrini O, Garnier J. LATE POSTPANCREATICODUODENECTOMY HEMORRHAGE: INCIDENCE, RISK FACTORS, MANAGEMENT AND OUTCOME. Shock 2022; 58:374-383. [PMID: 36445230 DOI: 10.1097/shk.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ABSTRACT Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P < 0.001), and C-reactive protein (CRP) concentration (P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.
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Affiliation(s)
- Mathieu Jacquemin
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Djamel Mokart
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Marion Faucher
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Jacques Ewald
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
| | - Maxime Tourret
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Clément Brun
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Marie Tezier
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Damien Mallet
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Lam Nguyen Duong
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Sylvie Cambon
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Camille Pouliquen
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Florence Ettori
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Antoine Sannini
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Frédéric Gonzalez
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Magali Bisbal
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | | | - Luca Servan
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | | | - Jean Marie Boher
- Unité de Biostatistique et de Méthodologie, Institut Paoli Calmette, France
| | - Olivier Turrini
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
| | - Jonathan Garnier
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
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Urine output and acute kidney injury following laparoscopic pancreas operations. HPB (Oxford) 2022; 24:1967-1974. [PMID: 35792029 DOI: 10.1016/j.hpb.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/18/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aims to assess if intraoperative urine output is associated with acute kidney injury (AKI) during laparoscopic pancreas surgery. METHODS Medical records of adult patients who underwent laparoscopic pancreas surgery from 2010 to 2020 were reviewed to identify patients who experienced AKI (creatinine increase of 0.3 mg/dL within 72 h). Surgeries were classified as with 'vascular reconstruction' (e.g. Whipple, total pancreatectomy) versus 'without reconstruction' (e.g., distal pancreatectomy). RESULTS Included were 365 patients (221 with and 114 without reconstruction), and 42 (11.4%) developed AKI (32 [14.5%] reconstruction and 10 [6.9%] without reconstruction (P = 0.164)). The median urine output for AKI group was 0.79 [0.43, 1.15] mL/kg/h and 0.88 [0.55, 1.53] mL/kg/h for non-AKI group, P = 0.121. Urine output between AKI and non-AKI did not vary among reconstruction cases (P = 0.383), but was lower in AKI patients without reconstruction (P = 0.047). Older age, preexisting kidney disease, higher disease burden, and intraoperative hypotension were associated with AKI. Postoperative course was more complicated for AKI patients including rates of pancreatic fistulas and mortality. CONCLUSION Incidence of AKI increases with more extensive surgery, but is not associated with low urine output. However, low urine output was associated with AKI in patients undergoing operation without reconstruction.
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Zhou Y, Liu S. Threshold heterogeneity of perioperative hemoglobin drop for acute kidney injury after noncardiac surgery: a propensity score weighting analysis. BMC Nephrol 2022; 23:206. [PMID: 35690725 PMCID: PMC9188693 DOI: 10.1186/s12882-022-02834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative hemoglobin drop after noncardiac surgery is associated with acute kidney injury (AKI). However, opinion on the tolerable difference in postoperative hemoglobin drop in patients with different preoperative hemoglobin levels does not reach a consensus. This study aimed to identify hemoglobin drop thresholds for AKI after noncardiac surgery stratified by preoperative hemoglobin levels. Method This was a single-center retrospective cohort study for elective noncardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The generalized additive model described the non-linear relationship between hemoglobin drop and AKI occurrence. The minimum P-value approach identified cut-off points of hemoglobin drop within postoperative 7 days for patients with or without preoperative anemia. Stratified by preoperative anemia, hemoglobin drop’s odds ratio as continuous, quintile and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting (PSW). Results Of the 35,631 surgery, 5.9% (2105 cases) suffered postoperative AKI. Non-linearity was found between hemoglobin drop and postoperative AKI occurrence. The thresholds and corresponding odds ratio of perioperative hemoglobin drop for patients with and without preoperative anemia were 18 g/L (1.38 (95%CI 1.14 -1.62), P < .001; after PSW: 1.42 (95%CI 1.17 -1.74), P < .001) and 43 g/L (1.81 (95%CI 1.35—2.27), P < .001; after PSW: 2.88 (95%CI 1.85—4.50), P < .001) respectively. Overall thresholds and corresponding odds ratio were 43 g/L (1.82 (95%CI 1.42—2.21)), P < .001; after PSW: 3.29 (95%CI 2.00—5.40), P < .001). Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that intraoperatively female patients undergoing intraperitoneal surgery without colloid infusion seemed to be more vulnerable to higher hemoglobin drop. Further analysis showed a possible linear relationship between preoperative hemoglobin and perioperative hemoglobin drop thresholds. Additionally, this study found that the creatinine level changed simultaneously with hemoglobin level within five postoperative days. Conclusions Heterogeneity of hemoglobin drop endurability exists after noncardiac non-kidney surgery. More care and earlier intervention should be put on patients with preoperative anemia. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02834-3.
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Affiliation(s)
- Yan Zhou
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China.
| | - Si Liu
- Department of Database Center, Peking University First Hospital, Beijing, 100034, China
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9
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Abstract
Approximately 7% of patients undergoing non-cardiac surgery with general anesthesia develop postoperative acute kidney injury (AKI). It is well-known that general anesthesia may have an impact on renal function and water balance regulation, but the mechanisms and potential differences between anesthetics are not yet completely clear. Recently published large animal studies have demonstrated that volatile (gas) anesthesia stimulates the renal sympathetic nervous system more than intravenous propofol anesthesia, resulting in decreased water and sodium excretion and reduced renal perfusion and oxygenation. Whether this is the case also in humans remains to be clarified. Increased renal sympathetic nerve activity may impair renal excretory function and oxygenation and induce structural injury in ischemic AKI models and could therefore be a contributing factor to AKI in the perioperative setting. This review summarizes anesthetic agents' effects on the renal sympathetic nervous system that may be important in the pathogenesis of perioperative AKI.
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10
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Zafar W, Kalra K, Ortiz-Melo DI. Oncosurgery-Related Acute Kidney Injury. Adv Chronic Kidney Dis 2022; 29:161-170.e1. [PMID: 35817523 DOI: 10.1053/j.ackd.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Oncosurgery is a surgical specialty that focuses on the diagnosis, staging, and management of cancer and cancer-related complications. Acute kidney injury is a common and important complication related to oncologic surgery, associated with longer hospital length of stay, greater costs, increased risk of incident or progressive chronic kidney disease (CKD), and higher mortality. The pathogenesis of oncosurgery-related acute kidney injury is multifactorial and determined by different variables, including patient characteristics (comorbidities, volume status, age, pre-existing CKD), specific cancer type or location, surgical procedure involved, as well as intrinsic neuroendocrine and hemodynamic responses to anesthesia and/or surgery. Early nephrology evaluation may be helpful to assist with preservation of kidney function and prevention of further kidney injury.
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Affiliation(s)
- Waleed Zafar
- Division of Nephrology, Geisinger Medical Center, Danville, PA
| | - Kartik Kalra
- Division of Nephrology, Geisinger Medical Center, Danville, PA
| | - David I Ortiz-Melo
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC.
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Zhao BC, Lei SH, Yang X, Zhang Y, Qiu SD, Liu WF, Li C, Liu KX. Assessment of prognostic value of intraoperative oliguria for postoperative acute kidney injury: a retrospective cohort study. Br J Anaesth 2020; 126:799-807. [PMID: 33342539 DOI: 10.1016/j.bja.2020.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Oliguria is often viewed as a sign of renal hypoperfusion and an indicator for volume expansion during surgery. However, the prognostic association and the predictive utility of intraoperative oliguria for postoperative acute kidney injury (AKI) are unclear. METHODS We conducted a retrospective cohort study on patients undergoing major thoracic surgery in an academic hospital to assess the association of intraoperative oliguria with postoperative AKI and its predictive value. To contextualise our findings, we included our results in a meta-analysis of observational studies on the importance of oliguria during noncardiac surgery. RESULTS In our cohort study, 3862 patients were included; 205 (5.3%) developed AKI after surgery. Intraoperative urine output of 0.3 ml kg-1 h-1 was the optimal threshold for oliguria in multivariable analysis. Patients with oliguria had an increased risk of AKI (adjusted odds ratio: 2.60; 95% confidence interval: 1.24-5.05). However, intraoperative oliguria had a sensitivity of 5.9%, specificity of 98%, positive likelihood ratio of 2.74, and negative likelihood ratio of 0.96, suggesting poor predictive ability. Moreover, it did not improve upon the predictive performance of a multivariable model, based on discrimination and reclassification indices. Our findings were generally consistent with the results of a systematic review and meta-analysis, including six additional studies. CONCLUSIONS Intraoperative oliguria has moderate association with, but poor predictive ability for, postoperative AKI. It remains of clinical interest as a risk factor potentially modifiable to interventions.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shao-Hui Lei
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Yang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ya Zhang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Da Qiu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-Feng Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cai Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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12
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Abstract
Acute kidney injury (AKI) is a common and critical clinical disorder with non-negligible morbidity and mortality and remains a large public health problem. Asia, as the world's largest and most populous continent, is crucial in eliminating unsatisfactory outcomes of AKI. The diversities in climate, customs, and economic status lead to various clinical features of AKI across Asia. In this review, we focus on the epidemiologic data and clinical features of AKI in different Asian countries and clinical settings, and we show the huge medical and economic burden of AKI in Asian countries. Drugs and sepsis are the most common etiologies for AKI, however, an adequate surveillance system has not been well established. There is significant undertreatment of AKI in many regions, and medical resources for renal replacement therapy are not universally available. Although substantial improvement has been achieved, health care for AKI still needs improvement, especially in developing regions.
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Affiliation(s)
- Junwen Huang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Damin Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
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Mahmooth Z, Jajja MR, Maxwell D, Ferez-Pinzon A, Sarmiento JM. Ultrarestrictive intraoperative intravenous fluids during pancreatoduodenectomy is not associated with an increase in post-operative acute kidney injury. Am J Surg 2020; 220:264-269. [DOI: 10.1016/j.amjsurg.2020.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023]
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Zhou Y, Yang HY, Zhang HL, Zhu XJ. High-density lipoprotein cholesterol concentration and acute kidney injury after noncardiac surgery. BMC Nephrol 2020; 21:149. [PMID: 32334566 PMCID: PMC7183648 DOI: 10.1186/s12882-020-01808-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Background Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 7 days postoperatively in the hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results Of the 74,284 surgeries, 4.4% (3159 cases) suffered acute kidney injury. The odds ratio for HDL (0.96–1.14 as reference, < 0.96, 1.14–1.35, > 1.35) was 1.28 (1.14–1.41), P < 0.001; 0.91 (0.80–1.03), P = 0.150; 0.75 (0.64–0.85), P < 0.001, respectively. Using a dichotomized cutoff point for propensity analysis, Preoperative serum HDL < 1.03 mmol/L (> 1.03 as reference) was associated with increased risk of postoperative AKI, with odds ratio 1.40 (1.27 ~ 1.52), P < 0.001 before propensity score weighting, and 1.32 (1.21–1.46), P < 0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions Using multivariate regression analyses before and after propensity score weighting, in addition to multiple sensitivity analysis methods, this study found that following non-cardiac surgery, low HDL cholesterol levels were independent risk factors for AKI.
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Affiliation(s)
- Yan Zhou
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China.
| | - Hong-Yun Yang
- Department of Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Hui-Li Zhang
- Department of information center, Peking University First Hospital, Beijing, 100034, China
| | - Xiao-Jin Zhu
- Department of information center, Peking University First Hospital, Beijing, 100034, China
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Zheng C, Guo C. Intraoperative Urine Output Is Associated with Postoperative Outcome in Pediatric Population Undergone Major Abdominal Operations. Ther Clin Risk Manag 2020; 15:1453-1460. [PMID: 31908465 PMCID: PMC6927263 DOI: 10.2147/tcrm.s228528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
Aim Few data support the advantage of confirming a low urine output target during Roux-en-Y hepaticojejunostomy, which was widely used as an indication for fluid administration. We aimed at evaluating postoperative outcomes in terms of urine output in pediatric patients undergoing elective Roux-en-Y hepaticojejunostomy. Methods We retrospectively reviewed 689 patients who had undergone Roux-en-Y hepaticojejunostomy between January 2007 and August 2014 at the Children’s Hospital of the Chongqing Medical University. Patients were dichotomized according to the average amount of corrected urine output (6.01 mL/kg*h) as a cut-off point. The primary endpoint was the occurrence of renal complications. The secondary endpoints included prompt postoperative gastrointestinal function recovery, postoperative complications and hospital length of stay. Results The lower urine output had a proportional association with lesser amounts of crystalloid fluids (12.99±6.52 and 17.36±7.74 mL/kg*h for low and high urine output, respectively, p=0.006). For patients with a lower urine output, there were trends toward lower incidence rates of grade II postoperative complications (OR, 0.68; 95CI, 0.45–1.03; p=0.041) and accelerated recovery of gastrointestinal function, as indicated by the first flatus (p=0.015) and first bowel movement (p=0.008); however, the occurrence of renal complications did not show significant differences between the groups. The total length of hospital stay was shorter in patients with low urine output (7.59±1.24 days) than that in patients with a high urine output (8.01±2.31 days, p = 0.016). Conclusion Lower urine output is associated with a lower incidence rate II postoperative complications and accelerated recovery of gastrointestinal function, without increasing the occurrence of renal complications in pediatric patient undergone hepaticojejunostomy. The optimal amount of urine output and associated fluid administration should be further investigated.
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Affiliation(s)
- Chao Zheng
- Department of Orthopedics, Children's Hospital, Chongqing Medical University, Chongqing 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chunbao Guo
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China
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Joliat GR, Labgaa I, Demartines N, Halkic N. Acute kidney injury after liver surgery: does postoperative urine output correlate with postoperative serum creatinine? HPB (Oxford) 2020; 22:144-150. [PMID: 31431415 DOI: 10.1016/j.hpb.2019.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/29/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after hepatectomy occurs in around 10% of cases. AKI is often defined based only on postoperative serum creatinine increase. This study aimed to assess if postoperative urine output (UO) correlated with serum creatinine after hepatectomy. METHODS All consecutive hepatectomy patients (2010-2016) were assessed. AKI was defined according to KDIGO criteria: serum creatinine increase ≥26.5 μmol/l, creatinine increase ≥1.5x baseline creatinine, or postoperative oliguria. Oliguria was defined as daily mean UO <0.5 mL/kg/h. AKI was subdivided into creatinine-based or oliguria-based AKI according to the defining criterion. RESULTS Out of 285 patients, AKI was observed in 79 cases (28%). Creatinine-based AKI occurred in 25 patients (9%) and oliguria-based only AKI in 54 patients (19%). Ten patients fulfilled both criteria (4%). Postoperative UO correlated poorly with postoperative serum creatinine level in both whole cohort (rho = -0.34, p <0.001) and AKI subgroup (rho = -0.189, p = 0.124). No association was found between postoperative oliguria and postoperative serum creatinine increase (HR = 0.5, 95%CI: 0.2-1.9, p = 0.341). On multivariable analysis, operation duration >360 minutes was the only predictor of creatinine increase (HR = 3.6, 95%CI: 1.1-11.4, p = 0.032). CONCLUSION Postoperative UO showed poor correlation with postoperative serum creatinine both in all patients and AKI patients. Surgery duration >360 minutes appeared as the only independent predictor of postoperative serum creatinine increase.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Assessing acute kidney injury following pancreatic surgery. Am J Surg 2017; 216:643. [PMID: 28847410 DOI: 10.1016/j.amjsurg.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
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