Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

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Abstract

Acute kidney injury (AKI) is a common complication in patients undergoing major abdominal surgery. Various recent studies using modern standardized classifications for AKI reported a variable incidence of AKI after major abdominal surgery ranging from 3 to 35%. Several patient-related, procedure-related factors and postoperative complications were identified as risk factors for AKI in this setting. AKI following major abdominal surgery has been shown to be associated with poor short- and long-term outcomes. Herein, we provide a contemporary and critical review of AKI after major abdominal surgery focusing on its incidence, risk factors, pathogeny and outcomes.

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Most cited references 88

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Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

Glenn Chertow, Elisabeth Burdick, Melissa M Honour … (2005)

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.

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Mechanisms of maladaptive repair after AKI leading to accelerated kidney ageing and CKD.

David A Ferenbach, Joseph V. Bonventre (2015)

Acute kidney injury is an increasingly common complication of hospital admission and is associated with high levels of morbidity and mortality. A hypotensive, septic, or toxic insult can initiate a cascade of events, resulting in impaired microcirculation, activation of inflammatory pathways and tubular cell injury or death. These processes ultimately result in acutely impaired kidney function and initiation of a repair response. This Review explores the various mechanisms responsible for the initiation and propagation of acute kidney injury, the prototypic mechanisms by which a substantially damaged kidney can regenerate its normal architecture, and how the adaptive processes of repair can become maladaptive. These mechanisms, which include G2/M cell-cycle arrest, cell senescence, profibrogenic cytokine production, and activation of pericytes and interstitial myofibroblasts, contribute to the development of progressive fibrotic kidney disease. The end result is a state that mimics accelerated kidney ageing. These mechanisms present important opportunities for the design of targeted therapeutic strategies to promote adaptive renal recovery and minimize progressive fibrosis and chronic kidney disease after acute insults.

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Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery.

Louise Y Sun, Duminda N. Wijeysundera, Gordon A Tait … (2015)

Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear. The authors investigated the association between varying periods of IOH with mean arterial pressure (MAP) less than 55, less than 60, and less than 65 mmHg with AKI.

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Author and article information

Contributors

Joana Gameiro: joana.estrelagameiro@gmail.com

José Agapito Fonseca: jose.nuno.agapito@gmail.com

Marta Neves: martaraq_neves@hotmail.com

Sofia Jorge: sofiacjorge@sapo.pt

José António Lopes: jalopes93@hotmail.com

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 9 February 2018

Publication date PMC-release: 9 February 2018

Publication date Collection: 2018

Volume: 8

Electronic Location Identifier: 22

Affiliations

ISNI 0000 0004 0474 1607, GRID grid.418341.b, Division of Nephrology and Renal Transplantation, Department of Medicine, , Centro Hospitalar Lisboa Norte, EPE, ; Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal

Article

Publisher ID: 369

DOI: 10.1186/s13613-018-0369-7

PMC ID: 5807256

PubMed ID: 29427134

SO-VID: 5cdca0c7-06e5-414e-b7a0-9b53a17db566

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 31 October 2017

Date accepted : 5 February 2018

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: acute kidney injury,postoperative,incidence,prognosis,risk factors,pathogenesis

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: acute kidney injury, postoperative, incidence, prognosis, risk factors, pathogenesis

Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

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Karger: Nephrology

Most cited references 88

Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

Mechanisms of maladaptive repair after AKI leading to accelerated kidney ageing and CKD.

Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery.

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