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Futamura Y, Watanuki H, Okada M, Sugiyama K, Matsuyama K. The Efficacy and Renal Protective Effect of Tolvaptan in Chronic Kidney Disease Patients after Open-Heart Surgery. Ann Thorac Cardiovasc Surg 2021; 27:317-321. [PMID: 34053960 PMCID: PMC8560536 DOI: 10.5761/atcs.oa.20-00364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Unlike loop diuretics, tolvaptan is reported to have a renal protective effect. The purpose of this study was to retrospectively assess the efficacy of tolvaptan administration in chronic kidney disease (CKD) patients following open-heart surgery. Methods: From February 2017 to August 2020, 75 patients with preoperative CKD stages IIIb–V were enrolled in this study and were divided into two groups: the control group (n = 30) and the tolvaptan group (n = 45). All patients routinely received conventional diuretics starting from postoperative day (POD) 1. Tolvaptan at 7.5–15 mg/day was administered if the patients had persistent fluid retention or poor response to conventional diuretics. Results: Tolvaptan administration was initiated at a mean of POD 2.9 ± 2.2, and the mean dosing period was 4.1 ± 3.0 days. The mean time to return to the preoperative body weight in the control and tolvaptan groups was similar. However, estimated glomerular filtration rate (eGFR) was significantly increased at the time when body weight reached the preoperative level and at discharge in the tolvaptan group than in the control group. Conclusion: This study demonstrated the renal protective effect of tolvaptan even in advanced CKD patients after open-heart surgery.
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Affiliation(s)
- Yasuhiro Futamura
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hirotaka Watanuki
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masaho Okada
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Katsuhiko Matsuyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Woo SH, Zavodnick J, Ackermann L, Maarouf OH, Zhang J, Cowan SW. Development and Validation of a Web-Based Prediction Model for AKI after Surgery. KIDNEY360 2021; 2:215-223. [PMID: 35373024 PMCID: PMC8740985 DOI: 10.34067/kid.0004732020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/28/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND AKI after surgery is associated with high mortality and morbidity. The purpose of this study is to develop and validate a risk prediction tool for the occurrence of postoperative AKI requiring RRT (AKI-dialysis). METHODS This retrospective cohort study had 2,299,502 surgical patients over 2015-2017 from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS NSQIP). Eleven predictors were selected for the predictive model: age, history of congestive heart failure, diabetes, ascites, emergency surgery, hypertension requiring medication, preoperative serum creatinine, hematocrit, sodium, preoperative sepsis, and surgery type. The predictive model was trained using 2015-2016 data (n=1,487,724) and further tested using 2017 data (n=811,778). A risk model was developed using multivariable logistic regression. RESULTS AKI-dialysis occurred in 0.3% (n=6853) of patients. The unadjusted 30-day postoperative mortality rate associated with AKI-dialysis was 37.5%. The AKI risk prediction model had high area under the receiver operating characteristic curve (AUC; training cohort: 0.89, test cohort: 0.90) for postoperative AKI-dialysis. CONCLUSIONS This model provides a clinically useful bedside predictive tool for postoperative AKI requiring dialysis.
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Affiliation(s)
- Sang H Woo
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jillian Zavodnick
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lily Ackermann
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omar H Maarouf
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jingjing Zhang
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott W Cowan
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Xu J, Yu J, Xu X, Shen B, Wang Y, Jiang W, Lv W, Fang Y, Luo Z, Wang C, Teng J, Ding X. Preoperative hidden renal dysfunction add an age dependent risk of progressive chronic kidney disease after cardiac surgery. J Cardiothorac Surg 2019; 14:151. [PMID: 31438993 PMCID: PMC6704689 DOI: 10.1186/s13019-019-0977-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background To study different value of estimated glomerular filtration rate with normal serum creatinine whether is a risk factor for hidden renal function of cardiac surgery outcomes. Methods A total of 1744 cardiac surgery patients with serum creatinine ≤1.2 mg/dL (female)/1.5 mg/dL (male) were divided into 3 groups: estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2 (no renal dysfunction, n = 829), 60 ≤ estimated glomerular filtration rate < 90 mL/min/1.73 m2 (hidden renal dysfunction, n = 857), estimated glomerular filtration rate < 60 mL/min/1.73 m2 (known renal dysfunction, n = 58) and followed up for 3 years. Multivariate regression analyses for risk factors of postoperative acute kidney injury. Results The proportion of preoperative hidden renal dysfunction was 67.1% among patients ≥ 65 years old and 44.1% among patients < 65 years old. Multivariate Cox regression analyses showed that for patients < 65 years, known renal dysfunction was a risk factor for postoperative acute kidney injury (P < 0.01) and progressive chronic kidney disease (P = 0.018), while hidden renal dysfunction was a risk factor for progressive chronic kidney disease (P = 0.024). For patients ≥ 65 years, only known renal dysfunction was a risk factors for 3-year mortality (P = 0.022) and progressive chronic kidney disease (P < 0.01). Conclusion Hidden renal dysfunction was common in patients with normal serum creatinine for cardiac surgery, with a prevalence of 49.1%. For patients < 65 years old, hidden renal dysfunction was an independent risk factor for progressive chronic kidney disease.
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Affiliation(s)
- Jiarui Xu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Jiawei Yu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Xialian Xu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Wuhua Jiang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Wenlv Lv
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China.,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China.,Hemodialysis Quality of Control Center of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Jie Teng
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China. .,Hemodialysis Quality of Control Center of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China. .,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No. 668 Jinhu Road, Xiamen, 361015, Fujian, China.
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Institute for Kidney and Dialysis, No. 180 Fenglin Road, Shanghai, 200032, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, No. 180 Fenglin Road, Shanghai, 200032, China. .,Hemodialysis Quality of Control Center of Shanghai, No. 180 Fenglin Road, Shanghai, 200032, China. .,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No. 668 Jinhu Road, Xiamen, 361015, Fujian, China.
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Dalton A, Zafirova Z. Preoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment. Anesthesiol Clin 2018; 36:599-614. [PMID: 30390781 DOI: 10.1016/j.anclin.2018.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the population ages, more geriatric patients will be presenting for surgical procedures. Preoperative evaluation seeks to assess patients for geriatric syndromes: frailty, sarcopenia, functional dependence, and malnutrition. Age-related changes in physiology increase risk for central nervous system, cardiovascular, pulmonary, renal, hepatic, and endocrine morbidity and mortality. Identification of various comorbidities allows for preoperative optimization and for opportunities for intervention including nutritional supplementation and prehabilitation, which may improve postoperative outcomes.
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Affiliation(s)
- Allison Dalton
- Department of Anesthesia and Critical Care, University of Chicago, 5041 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
| | - Zdravka Zafirova
- Section Critical Care, Department of Cardiovascular Surgery, Mount Sinai Hospital System, Icahn School of Medicine, Mount Sinai Medical Center, Box 1028, 1 Gustave L. Levy Place, New York, NY 10029, USA
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5
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Breivik H, Norum H, Fenger-Eriksen C, Alahuhta S, Vigfússon G, Thomas O, Lagerkranser M. Reducing risk of spinal haematoma from spinal and epidural pain procedures. Scand J Pain 2018; 18:129-150. [DOI: 10.1515/sjpain-2018-0041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractBackground and aims:Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory.Methods:We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures.Results and recommendations:Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients’ comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur.Conclusions:When neuraxial analgesia is considered for a patient on anti-haemostatic medication, with patient-related, or procedure-related risk factors, the balance of benefits against risks of bleeding is decisive; when CNB are offered exclusively to patients who will have a reduction of postoperative morbidity and mortality, then a higher risk of bleeding may be accepted. Robust routines should ensure appropriate discontinuation of anti-haemostatic drugs and early detection and treatment of SH.Implications:There is an on-going development of drugs for prevention of thromboembolic events following surgery and childbirth. The present practise advisory provides up-to-date knowledge and experts’ experiences so that patients who will greatly benefit from neuraxial pain procedures and have increased risk of bleeding can safely benefit from these procedures. There are always individual factors for the clinician to evaluate and consider. Increasingly it is necessary for the anaesthesia and analgesia provider to collaborate with specialists in haemostasis. Surgeons and obstetricians must be equally well prepared to collaborate for the best outcome for their patients suffering from acute or chronic pain. Optimal pain management is a prerequisite for enhanced recovery after surgery, but there is a multitude of additional concerns, such as early mobilisation, early oral feeding and ileus prevention that surgeons and anaesthesia providers need to optimise for the best outcome and least risk of complications.
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Affiliation(s)
- Harald Breivik
- Oslo University Hospital , Division of Emergencies and Critical Care, Department of Pain Management and Research , PB 4956 Nydalen, 0424 Oslo , Norway , Phone: +47 23073691, Fax: +47 23073690
- University of Oslo , Faculty of Medicine , Oslo , Norway
- Oslo University Hospital , Division of Emergencies and Critical Care, Department of Anaesthesiology , Oslo , Norway
| | - Hilde Norum
- University of Oslo , Faculty of Medicine , Oslo , Norway
- Oslo University Hospital , Division of Emergencies and Critical Care, Department of Anaesthesiology , Oslo , Norway
| | | | - Seppo Alahuhta
- Department of Anaesthesiology , MRC Oulu , University of Oulu, and Oulu University Hospital , Oulu , Finland
| | - Gísli Vigfússon
- Department of Anaesthesia and Intensive Care , University Hospital Landspitalinn , Reykjavik , Iceland
| | - Owain Thomas
- Institute of Clinical Sciences , University of Lund, and Department of Paediatric Anaesthesiology and Intensive Care , SUS Lund University Hospital , Lund , Sweden
| | - Michael Lagerkranser
- Section for Anaesthesiology and Intensive Care Medicine , Department of Physiology and Pharmacology , Karolinska Institute , Stockholm , Sweden
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6
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Hollinger A, Gantner L, Jockers F, Schweingruber T, Ledergerber K, Scheuzger JD, Aschwanden M, Dickenmann M, Knotzer J, van Bommel J, Siegemund M. Impact of amount of fluid for circulatory resuscitation on renal function in patients in shock: evaluating the influence of intra-abdominal pressure, renal resistive index, sublingual microcirculation and total body water measured by bio-impedance analysis on haemodynamic parameters for guidance of volume resuscitation in shock therapy: a protocol for the VoluKid pilot study–an observational clinical trial. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0156-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Gillies MA, Sander M, Shaw A, Wijeysundera DN, Myburgh J, Aldecoa C, Jammer I, Lobo SM, Pritchard N, Grocott MPW, Schultz MJ, Pearse RM. Current research priorities in perioperative intensive care medicine. Intensive Care Med 2017; 43:1173-1186. [PMID: 28597121 DOI: 10.1007/s00134-017-4848-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/17/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Surgical treatments are offered to more patients than ever before, and increasingly to older patients with chronic disease. High-risk patients frequently require critical care either in the immediate postoperative period or after developing complications. The purpose of this review was to identify and prioritise themes for future research in perioperative intensive care medicine. METHODS We undertook a priority setting process (PSP). A panel was convened, drawn from experts representing a wide geographical area, plus a patient representative. The panel was asked to suggest and prioritise key uncertainties and future research questions in the field of perioperative intensive care through a modified Delphi process. Clinical trial registries were searched for on-going research. A proposed "Population, Intervention, Comparator, Outcome" (PICO) structure for each question was provided. RESULTS Ten key uncertainties and future areas of research were identified as priorities and ranked. Appropriate intravenous fluid and blood component therapy, use of critical care resources, prevention of delirium and respiratory management featured prominently. CONCLUSION Admissions following surgery contribute a substantial proportion of critical care workload. Studies aimed at improving care in this group could have a large impact on patient-centred outcomes and optimum use of healthcare resources. In particular, the optimum use of critical care resources in this group is an area that requires urgent research.
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Affiliation(s)
- Michael A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Michael Sander
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-University, Giessen, Germany
| | - Andrew Shaw
- Department of Anesthesiology, Vanderbilt University Medical Centre, Nashville, TN, USA
| | | | - John Myburgh
- Department of Intensive Care Medicine, St George Clinical School, University of New South Wales, The George Institute for Global Health, Sydney, Australia.,The George Institute for Global Health, Newtown, Australia
| | - Cesar Aldecoa
- Department of Anaesthesia and Surgical Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ib Jammer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Suzana M Lobo
- Intensive Care Division, Hospital de Base de Sao Jose do Rio Preto, Sao Paulo, Brazil
| | | | - Michael P W Grocott
- Respiratory and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, SO16 6YD, UK
| | - Marcus J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (LEICA), Academic Medical Center, Amsterdam, Netherlands.,Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Park JT. Postoperative acute kidney injury. Korean J Anesthesiol 2017; 70:258-266. [PMID: 28580076 PMCID: PMC5453887 DOI: 10.4097/kjae.2017.70.3.258] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 01/07/2023] Open
Abstract
Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Several definitions of AKI have been proposed recently, and include both increases in serum creatinine levels and decreases in urine output as diagnostic criteria. The pathophysiology of postoperative AKI is complex and involves both ischemic injury and systemic inflammation. Identifying risk factors, such as old age, underlying diabetes, heart failure, and obesity, may aid in the application of preventative methods for postoperative AKI. Additionally, recognizing different risks after different types of surgical procedures would be valuable. Novel biomarkers that could detect AKI more precisely at an earlier time point are being investigated. Several new biomarkers have been assessed in large multi-center studies and are believed to accommodate conventional clinical findings in diagnosing postoperative AKI. In high-risk patients, preventative measures, such as the maintenance of adequate hemodynamics and sufficient fluid resuscitation, could lower the incidence of postoperative AKI. Avoiding nephrotoxic agents and optimizing preoperative hemoglobin levels to avoid excessive transfusions would also be beneficial. In situations in which medical management fails to maintain sufficient urine output and acid-base and electrolyte homeostasis, early initiation of renal replacement therapy should be considered.
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Affiliation(s)
- Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
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9
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Hong SE, Kim TY, Yoo JH, Kim JK, Kim SG, Kim HJ, Song YR. Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery. PLoS One 2017; 12:e0176259. [PMID: 28426743 PMCID: PMC5398695 DOI: 10.1371/journal.pone.0176259] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hip fracture is a common health problem in the elderly that is associated with increased mortality. Acute kidney injury (AKI) is a frequent complication in elderly patients undergoing surgery and is associated with the clinical outcome. We evaluated the incidence and risk factors of AKI in elderly patients undergoing hip fracture surgery and the impact of AKI on short- and long-term clinical outcomes. METHODS We performed a retrospective cohort study of 450 elderly patients who underwent hip fracture surgery between January 2010 and December 2012. We defined AKI according to the Acute Kidney Injury Network (AKIN) criteria and investigated the effect of AKI on the duration of hospital stay and in-hospital and long-term mortality. RESULTS Of the 450 patients, 95 (21.1%) developed AKI during hospitalization and 178 (39.6%) died, with a mean follow-up of 3.6 ± 1.0 years. The baseline serum creatinine level, use of angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists, red blood cell transfusion volume, and history of coronary artery disease were independent risk factors for AKI. Patients with AKI during hospitalization had significantly longer hospital stays and higher in-hospital and long-term mortality than those without AKI. Multivariate analysis revealed that age, history of coronary artery disease, serum albumin level, and AKI were independent predictors of long-term mortality. CONCLUSIONS AKI is a frequent complication in elderly patients undergoing hip fracture surgery and is independently associated with increased in-hospital and long-term mortality.
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Affiliation(s)
- Seong Eun Hong
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Tae-Young Kim
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Je-Hyun Yoo
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Hallym University Kidney Research Institute, Seoul, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Hallym University Kidney Research Institute, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Hallym University Kidney Research Institute, Seoul, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Hallym University Kidney Research Institute, Seoul, Korea
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10
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Umegaki T, Uba T, Sumi C, Sakamoto S, Jomura S, Hirota K, Shingu K. Impact of hydroxyethyl starch 70/0.5 on acute kidney injury after gastroenterological surgery. Korean J Anesthesiol 2016; 69:460-467. [PMID: 27703626 PMCID: PMC5047981 DOI: 10.4097/kjae.2016.69.5.460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 01/14/2023] Open
Abstract
Background Previous studies reported a higher mortality risk and a greater need for renal replacement therapy in patients administered hydroxyethyl starch (HES) rather than other fluid resuscitation preparations. In this study, we investigated the association between 6% HES 70/0.5 use and postoperative acute kidney injury (AKI) in gastroenterological surgery patients. Methods We conducted retrospective full-cohort and propensity-score-based analyses of patients who underwent gastroenterological surgery between June 2011 and August 2013 in a Japanese university hospital. The study sample comprised 66 AKI and 2,152 non-AKI patients in the full-cohort analysis and 35 AKI and 1,269 non-AKI patients in the propensity-score-based analysis. Propensity scores were calculated using an ordered logistic regression model in which the dependent variable comprised three groups based on HES infusion volumes (0, 1–999, and ≥ 1,000 ml). The association between HES groups and postoperative AKI incidence was analyzed using multiple logistic regression models. Other candidate independent variables included patient characteristics and intraoperative measures. Results In the full-cohort analysis, 40 (60.6%) AKI patients were diagnosed as "risk", 15 (22.7%) as "injury," and 11 (16.7%) as "failure". In the propensity-score-based analysis, the corresponding values were 22 (62.9%), 8 (22.9%), and 5 (14.3%). There was no significant association between total infused HES and postoperative AKI incidence in either the full-cohort or the propensity-score-based analysis (P = 0.168 and P = 0.42, respectively). Conclusions AKI incidence was not associated with clinical 6% HES 70/0.5 administration in gastroenterological surgery patients treated at a single center.
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Affiliation(s)
- Takeshi Umegaki
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Takeo Uba
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Chisato Sumi
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Sachiyo Sakamoto
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Sachiko Jomura
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Kiichi Hirota
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
| | - Koh Shingu
- Department of Anesthesiology, Hirakata Hospital, Kansai Medical University, Osaka, Japan
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12
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The high-risk patient: a challenge to be overcome. Curr Opin Crit Care 2014; 20:408-10. [PMID: 24914493 DOI: 10.1097/mcc.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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