Acute kidney disease beyond day 7 after major surgery : a secondary analysis of the EPIS-AKI trial
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
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| Enthalten in: |
Intensive care medicine - 50(2024), 2 vom: 01. Feb., Seite 247-257 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Meersch, Melanie [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney disease |
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| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 04.03.2024 published: Print-Electronic ClinicalTrials.gov: NCT04165369 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-023-07314-2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367754622 |
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| 100 | 1 | |a Meersch, Melanie |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Acute kidney disease beyond day 7 after major surgery |b a secondary analysis of the EPIS-AKI trial |
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| 500 | |a Date Completed 04.03.2024 | ||
| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT04165369 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a PURPOSE: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery | ||
| 520 | |a 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 | ||
| 520 | |a 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% | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney disease | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Chronic kidney disease | |
| 650 | 4 | |a Postoperative | |
| 650 | 4 | |a Surgery | |
| 700 | 1 | |a Weiss, Raphael |e verfasserin |4 aut | |
| 700 | 1 | |a Strauß, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Albert, Felix |e verfasserin |4 aut | |
| 700 | 1 | |a Booke, Hendrik |e verfasserin |4 aut | |
| 700 | 1 | |a Forni, Lui |e verfasserin |4 aut | |
| 700 | 1 | |a Pittet, Jean-Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Kellum, John A |e verfasserin |4 aut | |
| 700 | 1 | |a Rosner, Mitchell |e verfasserin |4 aut | |
| 700 | 1 | |a Mehta, Ravindra |e verfasserin |4 aut | |
| 700 | 1 | |a Bellomo, Rinaldo |e verfasserin |4 aut | |
| 700 | 1 | |a Rosenberger, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Zarbock, Alexander |e verfasserin |4 aut | |
| 700 | 0 | |a EPIS-AKI Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Makhloufi, Hichem |e investigator |4 oth | |
| 700 | 1 | |a Sakhraoui, Rachida |e investigator |4 oth | |
| 700 | 1 | |a Ouyahia, Amel |e investigator |4 oth | |
| 700 | 1 | |a Rais, Mounira |e investigator |4 oth | |
| 700 | 1 | |a Kouicem, Aya Tinhinane |e investigator |4 oth | |
| 700 | 1 | |a Derwish, Khawla |e investigator |4 oth | |
| 700 | 1 | |a Abdoun, Meriem |e investigator |4 oth | |
| 700 | 1 | |a Ouahab, Ilhem |e investigator |4 oth | |
| 700 | 1 | |a Bouaoud, Souad |e investigator |4 oth | |
| 700 | 1 | |a Tidjane, Anisse |e investigator |4 oth | |
| 700 | 1 | |a Rivera, Carlos Jose Pérez |e investigator |4 oth | |
| 700 | 1 | |a García, Juan Pablo |e investigator |4 oth | |
| 700 | 1 | |a Peng, Ke |e investigator |4 oth | |
| 700 | 1 | |a Ji, Fu-Hai |e investigator |4 oth | |
| 700 | 1 | |a Ma, Zheng-Min |e investigator |4 oth | |
| 700 | 1 | |a Elbahnasawy, Mohamed Gamal |e investigator |4 oth | |
| 700 | 1 | |a Elsalhawy, Shady |e investigator |4 oth | |
| 700 | 1 | |a Nafea, Ahmed Mahmoud |e investigator |4 oth | |
| 700 | 1 | |a Osman, Nermin A |e investigator |4 oth | |
| 700 | 1 | |a Emara, Moataz Maher |e investigator |4 oth | |
| 700 | 1 | |a Bonna, Mohamed Mamdouh |e investigator |4 oth | |
| 700 | 1 | |a Abdehaleem, Ibrahim Abdelmonaem |e investigator |4 oth | |
| 700 | 1 | |a Abbas, Ahmed Mohamed |e investigator |4 oth | |
| 700 | 1 | |a Abbas, Mostafa Samy |e investigator |4 oth | |
| 700 | 1 | |a Esmaeil, Hany Mostafa |e investigator |4 oth | |
| 700 | 1 | |a Joannes-Boyau, Oliver |e investigator |4 oth | |
| 700 | 1 | |a Legros, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Floch, Thierry |e investigator |4 oth | |
| 700 | 1 | |a Muccio, Salvatore |e investigator |4 oth | |
| 700 | 1 | |a Menage-Innocenti, Lison |e investigator |4 oth | |
| 700 | 1 | |a Brochet, Benjamin |e investigator |4 oth | |
| 700 | 1 | |a Leclercq-Rouget, Marion |e investigator |4 oth | |
| 700 | 1 | |a Geneve, Claire |e investigator |4 oth | |
| 700 | 1 | |a Mocarquer, Bernardita Valenzuela |e investigator |4 oth | |
| 700 | 1 | |a Aveline, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Vautier, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Nadaud, Julien |e investigator |4 oth | |
| 700 | 1 | |a Rimmelé, Thomas |e investigator |4 oth | |
| 700 | 1 | |a Cerro, Valérie |e investigator |4 oth | |
| 700 | 1 | |a Suria, Stéphanie |e investigator |4 oth | |
| 700 | 1 | |a Elmawieh, Jamie |e investigator |4 oth | |
| 700 | 1 | |a El-Jawiche, Rita |e investigator |4 oth | |
| 700 | 1 | |a Cirenei, Cédric |e investigator |4 oth | |
| 700 | 1 | |a Lebuffe, Gilles |e investigator |4 oth | |
| 700 | 1 | |a Ponsonnard, Sébastien |e investigator |4 oth | |
| 700 | 1 | |a Egreteau, Pierre-Yves |e investigator |4 oth | |
| 700 | 1 | |a Ichai, Carole |e investigator |4 oth | |
| 700 | 1 | |a Jean-Michel, Vanessa |e investigator |4 oth | |
| 700 | 1 | |a Léger, Maxime |e investigator |4 oth | |
| 700 | 1 | |a Lasocki, Sigismond |e investigator |4 oth | |
| 700 | 1 | |a Masson, Charline |e investigator |4 oth | |
| 700 | 1 | |a Rineau, Emmanuel |e investigator |4 oth | |
| 700 | 1 | |a Cassisa, Viviane |e investigator |4 oth | |
| 700 | 1 | |a Verrier, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Atchade, Enora |e investigator |4 oth | |
| 700 | 1 | |a Rochon, Charles-Edouard |e investigator |4 oth | |
| 700 | 1 | |a Quentin, Vidal |e investigator |4 oth | |
| 700 | 1 | |a Queixalos, Nina |e investigator |4 oth | |
| 700 | 1 | |a Braun, Thierry |e investigator |4 oth | |
| 700 | 1 | |a Grand, Hubert |e investigator |4 oth | |
| 700 | 1 | |a Mayeur, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Pasquie, Marie |e investigator |4 oth | |
| 700 | 1 | |a Garçon, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Bruckert, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Pradel, Gaël |e investigator |4 oth | |
| 700 | 1 | |a Ramorasata, Andersen |e investigator |4 oth | |
| 700 | 1 | |a Ravry, Céline |e investigator |4 oth | |
| 700 | 1 | |a Mottard, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Zarbock, Alexander |e investigator |4 oth | |
| 700 | 1 | |a Meersch, Melanie |e investigator |4 oth | |
| 700 | 1 | |a Weiss, Raphael |e investigator |4 oth | |
| 700 | 1 | |a von Groote, Thilo |e investigator |4 oth | |
| 700 | 1 | |a Dörr, Christian |e investigator |4 oth | |
| 700 | 1 | |a Küllmar, Mira |e investigator |4 oth | |
| 700 | 1 | |a Massoth, Christina |e investigator |4 oth | |
| 700 | 1 | |a Motekallemi, Arash |e investigator |4 oth | |
| 700 | 1 | |a Saadat-Gilani, Khaschayar |e investigator |4 oth | |
| 700 | 1 | |a Albert, Felix |e investigator |4 oth | |
| 700 | 1 | |a Kerschke, Laura |e investigator |4 oth | |
| 700 | 1 | |a Storck, Michael |e investigator |4 oth | |
| 700 | 1 | |a Varghese, Julian |e investigator |4 oth | |
| 700 | 1 | |a Wempe, Carola |e investigator |4 oth | |
| 700 | 1 | |a Grüßer, Linda |e investigator |4 oth | |
| 700 | 1 | |a Kowark, Ana |e investigator |4 oth | |
| 700 | 1 | |a Brandenburger, Timo |e investigator |4 oth | |
| 700 | 1 | |a Hohn, Andreas |e investigator |4 oth | |
| 700 | 1 | |a Rosenberger, Peter |e investigator |4 oth | |
| 700 | 1 | |a Häberle, Helene |e investigator |4 oth | |
| 700 | 1 | |a Hofmann, Pascal |e investigator |4 oth | |
| 700 | 1 | |a Kuhle, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Calov, Stefanie |e investigator |4 oth | |
| 700 | 1 | |a Bernard, Alice Marie |e investigator |4 oth | |
| 700 | 1 | |a Mirakaj, Valbona |e investigator |4 oth | |
| 700 | 1 | |a Weber, Kathrin |e investigator |4 oth | |
| 700 | 1 | |a Pfister, Kathrin |e investigator |4 oth | |
| 700 | 1 | |a Stetz, Lena |e investigator |4 oth | |
| 700 | 1 | |a Müller, Sarah Dorothea |e investigator |4 oth | |
| 700 | 1 | |a Klaus, Stephan |e investigator |4 oth | |
| 700 | 1 | |a Sadlo, Marco |e investigator |4 oth | |
| 700 | 1 | |a Sengelhoff, Christian |e investigator |4 oth | |
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