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

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dc.authorscopusid16203350300
dc.authorscopusid56666558100
dc.authorscopusid58647265700
dc.authorscopusid57948416100
dc.authorscopusid57218401073
dc.authorscopusid7006309884
dc.authorscopusid57204254597
dc.contributor.authorMeersch M.
dc.contributor.authorWeiss R.
dc.contributor.authorStrauß C.
dc.contributor.authorAlbert F.
dc.contributor.authorBooke H.
dc.contributor.authorForni L.
dc.contributor.authorPittet J.
dc.date.accessioned2024-08-04T19:59:23Z
dc.date.available2024-08-04T19:59:23Z
dc.date.issued2024
dc.departmentİnönü Üniversitesien_US
dc.description.abstractPurpose: 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. © The Author(s) 2024.en_US
dc.description.sponsorshipBaxter International; Deutsche Forschungsgemeinschaft, DFG: KFO342-1, ME5413/1-1, ME5413/1-2, ZA428/18-1, ZA428/21-1; Deutsche Forschungsgemeinschaft, DFGen_US
dc.description.sponsorshipOpen Access funding enabled and organized by Projekt DEAL. The study was supported by the German Research Foundation (KFO342-1, ZA428/18-1, and ZA428/21-1 to AZ and ME5413/1-1 and ME5413/1-2 to MM) and by an unrestricted research grant from Baxter (to AZ).en_US
dc.identifier.doi10.1007/s00134-023-07314-2
dc.identifier.endpage257en_US
dc.identifier.issn0342-4642
dc.identifier.issue2en_US
dc.identifier.pmid38285051en_US
dc.identifier.scopus2-s2.0-85183393467en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage247en_US
dc.identifier.urihttps://doi.org/10.1007/s00134-023-07314-2
dc.identifier.urihttps://hdl.handle.net/11616/90593
dc.identifier.volume50en_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherSpringer Science and Business Media Deutschland GmbHen_US
dc.relation.ispartofIntensive Care Medicineen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAcute kidney diseaseen_US
dc.subjectAcute kidney injuryen_US
dc.subjectChronic kidney diseaseen_US
dc.subjectPostoperativeen_US
dc.subjectSurgeryen_US
dc.titleAcute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trialen_US
dc.typeArticleen_US

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