Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

著者: 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, Julian Varghese, Carola Wempe, Linda Grüßer, Ana Kowark, Timo Brandenburger, Andreas Höhn, Peter Rosenberger, 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, Wegdan Khalel, 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, E. V. Grigoryev, A. A. Ivkin, Dmitriy Balakhnin, Д. Л. Шукевич, Michael Yaroustovsky, Abdulnaser Barmou, Alexander Kaserer, Clara Castellucci, Samira Akbas, Andreja Möller Petrun, Irena Gregorcic, Vesna Sok, Andre Links, Elizabeth Bárcena Barreto, Javier Ripollés‐Melchor, Ángel Ignacio Lledó Becerra, Aurelio Rodríguez, Javier Mata Estévez, Juan Mulet Matas, Sara Pérez Palao, Mercedes García Álvarez, 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, Félix Lobato, Marta Aguado Sevilla, Andres Erazo, Berta Castellano Paulis, Isabel de la Calle Gil, Peter Adamove, Francho Miguel Blasco Blasco, Jose I. García, Sara García Zamorano, Natalia Gijón Herreros, Raquel Callejas, Mercedes Estaire Gómez, Ángel M. Candela-Toha, 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, Patricia Galán Menéndez, 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, Vin‐Cent Wu, Mukadder Orhan Sungur, 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, Öznur Şen, Kamil Darçın, Semra Ugur, Yavuz Gürkan, Kemal Tolga Saraçoğlu, Özge Yıldız-Koyuncu, Aslı Demir, Aysun Postacı, Ayşegül Özgök, Ümit Karadeniz, Hülya Yiğit Özay, Eda Balcı, Nevriye Salman, Behiç Girgin, Özlem Sağır, 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, Kristen Rutledge, Ahmed Albishti, Mohamed Alsori, Salmi Hamza Abrayik - Intensive Care Medicine 2023 被引用: 150

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.