Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
Melanie Meersch, Raphael Weiß, Christian Strauß, Felix Albert, Hendrik Booke, Lui G. Forni, Jean‐François Pittet, John A. Kellum, Mitchell H. Rosner, Ravindra L. Mehta, Rinaldo Bellomo, Peter Rosenberger, Alexander Zarbock, the EPIS-AKI Investigators, Hichem Makhloufi, Rachida Sakhraoui, Amel Ouyahia, Mounira Rais, Aya Tinhinane Kouicem, Khawla Derwish, Meriem Abdoun, Ilhem Ouahab, Souad Bouaoud, Anisse Tidjane, Carlos J. Pérez-Rivera, Juan Pablo Garćıa-Vázquez, Ke Peng, Fuhai Ji, Zhengmin Ma, Mohamed Elbahnasawy, Shady Elsalhawy, Ahmed Mahmoud Nafea, Nermin A. Osman, Moataz Maher Emara, Mohamed Mamdouh Bonna, Ibrahim Abdelmonaem Abdehaleem, Ahmed M. Abbas, Mostafa Samy Abbas, Hany Mostafa Esmaeil, Oliver Joannes-Boyau, Vincent Legros, Thierry Floch, Salvatore Muccio, Lison Menage-Innocenti, Benjamin Brochet, Marion Leclercq-Rouget, Claire Genève, Bernardita Valenzuela Mocarquer, Christophe Aveline, Pierre Vautier, J. Nadaud, Thomas Rimmelé, Valérie Cerro, Stéphanie Suria, Jamie Elmawieh, Rita El-Jawiche, Cédric Cirenei, Gilles Lebuffe, S. Ponsonnard, Pierre-Yves Egreteau, Carole Ichaï, Vanessa Jean-Michel, Maxime Léger, Sigismond Lasocki, Charline Masson, Emmanuel Rineau, Viviane Cassisa, Pierre Verrier, Enora Atchade, Charles-Edouard Rochon, V. Quentin, Nina Queixalos, Thierry Braun, Hubert Grand, Nicolas Mayeur, M Pasquié, Pierre Garçon, Vincent Bruckert, Gaël Pradel, Andersen Ramorasata, Céline Ravry, Nicolas Mottard, Alexander Zarbock, Melanie Meersch, Raphael Weiss, Thilo von Groote, Christian Dörr, Mira Küllmar, Christina Massoth, Arash Motekallemi, Khaschayar Saadat-Gilani, Felix Albert, Laura Kerschke, Michael Storck, Julian Varghese, Carola Wempe, Linda Grüßer, Ana Kowark, Timo Brandenburger, Andreas Höhn
Abstract
PURPOSE: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. METHODS: 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.