Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Alexander Zarbock(Outcomes Research Consortium), Raphael Weiß(University Hospital Münster), Felix Albert(University of Münster), Kristen Rutledge(University of Alabama at Birmingham), John A. Kellum(University of Pittsburgh), Rinaldo Bellomo(The Royal Melbourne Hospital), E. V. Grigoryev(Kemerovo Cardiology Center), Ángel M. Candela-Toha(Hospital Universitario Ramón y Cajal), Aslı Demir(Sağlık Bilimleri Üniversitesi), Vincent Legros(Centre Hospitalier Universitaire de Reims), Peter Rosenberger(University Children's Hospital Tübingen), Patricia Galán Menéndez(Vall d'Hebron Hospital Universitari), Mercedes García Álvarez(Hospital de Sant Pau), Ke Peng(Soochow University), Maxime Léger(Centre Hospitalier Universitaire d'Angers), Wegdan Khalel(Tripoli Central Hospital), Mukadder Orhan Sungur(Istanbul University), Melanie Meersch(University Hospital Münster), 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(Hospital de Sant Pau), Juan Pablo Garćıa-Vázquez(Soochow University), Ke Peng(Soochow University), Fuhai Ji(Centre Hospitalier Universitaire d'Angers), Zhengmin Ma(University Children's Hospital Tübingen), 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(Centre Hospitalier Universitaire de Reims), Vincent Legros(Centre Hospitalier Universitaire de Reims), 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(Centre Hospitalier Universitaire d'Angers), Maxime Léger(Centre Hospitalier Universitaire d'Angers), 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(Centre Hospitalier Universitaire de Reims), Vincent Bruckert, Gaël Pradel, Andersen Ramorasata, Céline Ravry, Nicolas Mottard(Outcomes Research Consortium), Alexander Zarbock(Outcomes Research Consortium), Melanie Meersch(University Hospital Münster), Raphael Weiß(University Hospital Münster), Thilo von Groote, Christian Dörr, Mira Küllmar, Christina Massoth, Arash Motekallemi, Khaschayar Saadat-Gilani(University of Münster), Felix Albert(University of Münster), Laura Kerschke, Michael Storck, Julian Varghese, Carola Wempe, Linda Grüßer, Ana Kowark, Timo Brandenburger, Andreas Höhn(University Children's Hospital Tübingen), Peter Rosenberger(University Children's Hospital Tübingen), Helene Häberle, Pascal Hofmann, Jonathan Kuhle, Stefanie Calov, Alice Bernard, Valbona Mirakaj, Kathrin Weber, Kathrin Pfister, Lena Stetz, Sarah Dorothea Müller, Stephan Klaus, Marco Sadlo, Carina-Kristin Stenger, U. Göbel, Matthias Heringlake, Eleni Αrnaoutoglou, Panagiota Stratigopoulou, Pantazi Danai, Antonia Dimakopoulou, Apostolos-Alkiviadis Menis, Orestis Ioannidis, Humam Jalaawiy, Aeshah Anwar, Hashim Talib Hashim, Hogir Imad Rasheed Aldawoody, Andrea Cortegiani, Mariachiara Ippolito, Claudia Marino, Gabriele Presti, Dario Calogero Fricano, Silvia De Rosa, Andrea Bianchin, Gianluca Paternoster, Umberto Fasciano, Salvatore Lucio Cutuli, Savino Spadaro, Enrico Bussolati, Marco Palmieri, Carlo Alberto Volta, Vincenzo Francesco Tripodi, D Fiume, Angela Iuorio, Clemente Santorsola, Bilal Abu-Hussein, Khaled Hasanein, Seokyung Shin, Jongyoon Baek, Sehui Kim, Muhammed Elhadi, Wafa Aldressi, Issa Abuzeid, Mohammed N. Albaraesi, Mohamed Aziz Moftah, Sarah Aldressi(Tripoli Central Hospital), Wegdan Khalel(Tripoli Central Hospital), Eman Abdulwahed, Entisar Alshareea, Akram Abdulhamid Ashur Abujrad, Reem Ghmagh, Marwa Biala, Khawla Derwish, Rayet Al Islam Benjouira, Mohamed Aliwa, Ahmed Msherghi, Ahmed Tuwaib, Tahani Mustafa, Haifa Zriba, Hamza Mahmoud Agilla, Bahaeddin Taher Sadek Ben Hamida, Rema Hassan Mohamed Otman, Maja Mojsova Mijovska, Anne Marie Camilleri Podesta, Gilberto Adrián Gasca López, Sarah Amro, Rita Regufe(Kemerovo Cardiology Center), E. V. Grigoryev(Kemerovo Cardiology Center), A. A. Ivkin, Dmitriy Balakhnin, Д. Л. Шукевич, Michael Yaroustovsky, Abdulnaser Barmou(Outcomes Research Consortium), Alexander Kaserer, Clara Castellucci, Samira Akbas, Andreja Möller Petrun, Irena Gregorcic, Vesna Sok, Andre Links, Elizabeth Bárcena Barreto, Javier Ripollés‐Melchor(Hospital Universitario Ramón y Cajal), Ángel Ignacio Lledó Becerra, Aurelio Rodríguez, Javier Mata Estévez, Juan Mulet Matas, Sara Pérez Palao(Hospital de Sant Pau), Mercedes García Álvarez(Hospital de Sant Pau), Albert Bainac Albadalejo, Astrid Batalla González, Ana María Gómez, Ignacio Hinojal Blanco, Diego Toral Fernandez, Gracia Herranz Perez, Margarita Logroño Ejea, N. Ruiz, María Gastaca Abasolo, Lourdes Ferreira(University of Münster), Félix Lobato, Marta Aguado Sevilla, Andres Erazo, Berta Castellano Paulis, Isabel de la Calle Gil(University Children's Hospital Tübingen), Peter Adamove, Francho Miguel Blasco Blasco, Jose I. García, Sara García Zamorano, Natalia Gijón Herreros, Raquel Callejas, Mercedes Estaire Gómez(Hospital Universitario Ramón y Cajal), Ángel M. Candela-Toha(Hospital Universitario Ramón y Cajal), Elisabeth Claros-Llamas, Pilar Cobeta-Orduña, Pascual Agustín Crespo-Aliseda, Trinidad Dorado-Díaz, María Gómez Rojo, M. Nuria Mané-Ruiz, M. Carmen Martín-González, Adolfo Martínez, Carlos Tiscar(Vall d'Hebron Hospital Universitari), Patricia Galán Menéndez(Vall d'Hebron Hospital Universitari), Verónica Estepa Calvo, Laura Llinares Espí, Yuri Santiago Loaiza Aldeán, Víctor Morales Ariza, Laura Villarino Vila, Francisco Javier García-Miguel, Elfayadh S. M. Suliman, Ahmed Ibrahim, Hammad Ali Fadlalmola, Sarya Swed(Centre Hospitalier Universitaire de Reims), Vin‐Cent Wu(Istanbul University), Mukadder Orhan Sungur(Istanbul University), Demet Altun, Nur Canbolat, Bora Dinç, Serap Aktas Yildirim, Müzeyyen İyigün, Davud Yapıcı, Levent Özdemir, Aslınur Sagün, Neval Boztuğ, Emel Gündüz, Demet Lafli-Tunay, Deni̇z Karakaya, Burhan Dost, Özgür Kömürcü, Özlem Korkmaz Dilmen, Eren Fatma Akçıl, Yusuf Tunalı, Gülay Ok, Eda Tok-Alsina, Cengiz Polat, Nurcan Kızılcık(University Children's Hospital Tübingen), Öznur Şen, Kamil Darçın, Semra Ugur, Yavuz Gürkan, Kemal Tolga Saraçoğlu, Özge Yıldız-Koyuncu(Sağlık Bilimleri Üniversitesi), Aslı Demir(Sağlık Bilimleri Üniversitesi), Aysun Postacı, Ayşegül Özgök, Ümit Karadeniz, Hülya Yiğit Özay, Eda Balcı, Nevriye Salman, Behiç Girgin, Özlem Sağır(Sağlık Bilimleri Üniversitesi), Hafize Fisun Demir, Fatih Ugün, Hüseyin İlksen Toprak, Mustafa Soner Özcan, Filiz Alkaya-Solmaz, Mehmet Birhan Yılmaz, Ümran Karaca, Sevtap Hekimoglu Şahin, Süheyla Karadağ Erkoç, Neslihan Alkış, Volkan Baytaş, Engin Ertürk, Sedat Saylan, Ali Akdoğan, Beyza Büyükgebiz Yeşil, Ömer Faruk Boran, Yavuz Orak, Feyza Çalışır, Sibel Büyükçoban, Bahar Kuvaki, Seda Cansabuncu, Selcan Akesen, Suna Gören, Tuğçe Yeniocak, Osman Orman, Özlem Ersoy Karka, Tülay Şahin, Natalia Momot, Anna R. Panchenko, Jean‐François Pittet(University of Alabama at Birmingham), Kristen Rutledge(University of Alabama at Birmingham), Ahmed Albishti, Mohamed Alsori, Salmi Hamza Abrayik
Cited by 148Open Access
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.
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