Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Alexander Zarbock, Raphael Weiß, Felix Albert, Kristen Rutledge, John A. Kellum, Rinaldo Bellomo, E. V. Grigoryev, Ángel M. Candela-Toha, Aslı Demir, Vincent Legros, Peter Rosenberger, Patricia Galán Menéndez, Mercedes García Álvarez, Ke Peng, Maxime Léger, Wegdan Khalel, Mukadder Orhan Sungur, Melanie Meersch, 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, Peter Sklienka, 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
Abstract
PURPOSE: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. METHODS: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. RESULTS: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. CONCLUSION: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.