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

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

Erturk, Engin; Saracoglu, Kemal Tolga; Gürkan, Yavuz; Uğur, Semra; Mustafa, Tahani; Darçın, Kamil; Zriba, Haifa; Agilla, Hamza Mahmoud; Sadek Ben Hamida, Bahaeddin Taher; Mohamed Otman, Rema Hassan; Braun, Thierry; Ramorasata, Andersen; Pradel, Gaël; Grand, Hubert; Fadlalmola, Hammad Ali.; Mayeur, Nicolas; Pasquie, Marie; Garçon, Pierre; Bruckert, Vincent; Marco, Palmieri; Alberto, Volta Carlo; Tripodi, Vincenzo Francesco; Demir, Z. Aslı; Fiume, Diego; Iuorio, Angela; Santorsola, Clemente; Abu-Hussein, Bilal; Hasanein, Khaled; Shin, Seokyung; Postacı, N. Aysun; Baek, Jongyoon; Kim, Sehui; Özgök, Ayşegül; Karadeniz, Ümit; Özay, Hülya Yiğit; Balcı, Eda; Elhadi, Muhammed; Aldressi, Wafa; Salman, Nevriye; Girgin, Behiç; Sagir, Ozlem; Yıldız-Koyuncu, Özge; Abuzeid, Issa A.; Albaraesi, Mohammed N.; Demir, Hafize Fisun; Ugun, Fatih; Toprak, Hüseyin İlksen; Moftah, Mohamed Aziz; Aldressi, Sarah; Khalel, Wegdan; Abdulwahed, Eman; Ali Alshareea, Entisar Ahmed; Cutuli, Salvatore Lucio; Abujrad Reem Ghmagh, Akram Abdulhamid Ashur; Biala, Marwa Isa; Benjouira, Rayet Al Islam; Yilmaz, Mehmet; Aliwa, Mohamed; Karaca, Umran; Şahin, Sevtap Hekimoglu; Msherghi, Ahmed; Tuwaib, Ahmed; Erkoç, Süheyla Karadağ; Alkış, Neslihan; Baytaş, Volkan; Mijovska, Maja Mojsova; Podesta, Anne Marie Camilleri; Gasca López, Gilberto Adrián; Amro, Sarah; de Freitas Regufe, Rita; Grigoryev, Evgeny; Ivkin, Artem; Balakhnin, Dmitriy; Shukevich, Dmitriy; Saylan, Sedat; Akdogan, Ali; Yeşil, Beyza Büyükgebiz; Boran, Omer Faruk; Yaroustovsky, Michael; Fasciano, Umberto; Barmou, Abdulnaser; Orak, Yavuz; Çalişir, Feyza; Büyükçoban, Sibel; Kuvaki, Bahar; Kaserer, Alexander; Castellucci, Clara; Hashim, Hashim Talib; Cansabuncu, Seda; Akesen, Selcan; Enrico, Bussolati; Gören, Suna; Yeniocak, Tugce; Orman, Osman; Anwar, Aeshah; Karka, Özlem Ersoy; Sahin, Tulay; Momot, Natalia; Panchenko, Anna; Pittet, Jean-Francois; Rutledge, Kristen; Jalaawiy, Humam; Akbas, Samira; Şen, Öznur; Ioannidis, Orestis; Paternoster, Gianluca; Kızılcık, Nurcan; Polat, Cengiz; Petrun, Andreja Möller; Gregorcic, Irena; Sok, Vesna; Tok-Alsina, Eda; Ok, Gulay; Tunali, Yusuf; Bianchin, Andrea; Akcil, Eren Fatma; Links, Andre; Menis, Apostolos-Alkiviadis; Özcan, Mustafa Soner; Alkaya-Solmaz, Filiz; De Rosa, Silvia; Barreto, Elizabeth Bárcena; Melchor, Javier Ripollés; Becerra-Bolaños, Ángel; Dilmen, Ozlem Korkmaz; Komurcu, Ozgur; Rodríguez-Pérez, Aurelio; Dost, Burhan; Estévez, Javier Mata; Matas, Juan Mulet; Palao, Sara Pérez; Álvarez, Mercedes García; Albadalejo, Albert Bainac; Karakaya, Deniz; Lafli-Tunay, Demet; Fricano, Dario Calogero; González, Astrid Batalla; Caro, Ana María Gómez; Blanco, Ignacio Hinojal; Fernandez, Diego Toral; Perez, Gracia Herranz; Dimakopoulou, Antonia; Gündüz, Emel; Ejea, Margarita Logroño; de la Rosa Ruiz, Noelia; Abasolo, María Gastaca; Boztug, Neval; Ferreira, Lourdes; Lobato, Félix; Sevilla, Marta Aguado; Erazo, Andres; Paulis, Berta Castellano; de la Calle Gil, Isabel; Sagün, Aslınur; Özdemir, Levent; Adamove, Peter; Blasco, Francho Miguel Blasco; Yapıcı, Davud; García-Sánchez, Jose Ignacio; Savino, Spadaro; Zamorano, Sara García; Iyigun, Muzeyyen; Herreros, Natalia Gijón; Callejas, Raquel; Gómez, Mercedes Estaire; Yildirim, Serap Aktas; Candela-Toha, Angel M.; Claros-Llamas, Elisabeth; Cobeta-Orduña, Pilar; Crespo-Aliseda, Pascual; Dorado-Díaz, Trinidad; Gómez-Rojo, María; Mané-Ruiz, M. Nuria; González, M. Carmen Martín-; Danai, Pantazi; Dinçer, Müşerref Beril; Martínez-Pérez, Adolfo; Stratigopoulou, Panagiota; Cortegiani, Andrea; Rasheed Aldawoody, Hogir Imad; Canbolat, Nur; Altun, Demet; Arnaoutoglou, Eleni; Tiscar, Carlos; Menéndez, Patricia Galán; Calvo, Verónica Estepa; Espí, Laura Llinares; Orhan-Sungur, Mukadder; Wu, Vin-Cent; Heringlake, Matthias; Presti, Gabriele; Aldeán, Yuri Santiago Loaiza; Göbel, Ulrich; Stenger, Carina-Kristin; Sengelhoff, Christian; Ippolito, Mariachiara; Ariza, Víctor Morales; Sadlo, Marco; Klaus, Stephan; Müller, Sarah Dorothea; Marino, Claudia; Stetz, Lena; Vila, Laura Villarino; García-Miguel, Francisco Javier; Suliman, Elfayadh S. M.; Pfister, Kathrin; Meersch, Melanie; Weiss, Raphael; Strauß, Christian; Albert, Felix; Weber, Kathrin; Mirakaj, Valbona; Bernard, Alice Marie; Calov, Stefanie; Booke, Hendrik; Forni, Lui; Pittet, Jean-Francois; Kellum, John A.; Rosner, Mitchell; Mehta, Ravindra; Bellomo, Rinaldo; Rosenberger, Peter; Zarbock, Alexander; Makhloufi, Hichem; Sakhraoui, Rachida; Ouyahia, Amel; Rais, Mounira; Kouicem, Aya Tinhinane; Derwish, Khawla; Abdoun, Meriem; Ouahab, Ilhem; Bouaoud, Souad; Tidjane, Anisse; Pérez Rivera, Carlos Jose; García, Juan Pablo; Peng, Ke; Ji, Fu-Hai; Ma, Zheng-Min; Elbahnasawy, Mohamed Gamal; Kuhle, Jonathan; Elsalhawy, Shady; Hofmann, Pascal; Nafea, Ahmed Mahmoud; Swed, Sarya; Häberle, Helene; Osman, Nermin A.; Emara, Moataz Maher; Bonna, Mohamed Mamdouh; Abdehaleem, Ibrahim Abdelmonaem; Ibrahim, Ahmed Mohamed; Hohn, Andreas; Abbas, Ahmed Mohamed; Abbas, Mostafa Samy; Brandenburger, Timo; Kowark, Ana; Esmaeil, Hany Mostafa; Joannes-Boyau, Oliver; Legros, Vincent; Floch, Thierry; Grüßer, Linda; Muccio, Salvatore; Menage-Innocenti, Lison; Brochet, Benjamin; Leclercq-Rouget, Marion; Geneve, Claire; Mocarquer, Bernardita Valenzuela; Aveline, Christophe; Vautier, Pierre; Wempe, Carola; Nadaud, Julien; Rimmelé, Thomas; Cerro, Valérie; Varghese, Julian; Suria, Stéphanie; Elmawieh, Jamie; El-Jawiche, Rita; Cirenei, Cédric; Lebuffe, Gilles; Ponsonnard, Sébastien; Egreteau, Pierre-Yves; Storck, Michael; Ichai, Carole; Jean-Michel, Vanessa; Kerschke, Laura; Léger, Maxime; Saadat-Gilani, Khaschayar; Lasocki, Sigismond; Masson, Charline; Rineau, Emmanuel; Cassisa, Viviane; Verrier, Pierre; Motekallemi, Arash; Massoth, Christina; Küllmar, Mira; Dörr, Christian; von Groote, Thilo; Atchade, Enora; Rochon, Charles-Edouard; Quentin, Vidal; Mottard, Nicolas; Ravry, Céline; Queixalos, Nina
URI: http://acikerisim.sdu.edu.tr/xmlui/handle/123456789/101949

Description:

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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