Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory.

Details

Serval ID
serval:BIB_A49E30C9BA98
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory.
Journal
World journal of surgery
Author(s)
Grass F., Lovely J.K., Crippa J., Mathis K.L., Hübner M., Larson D.W.
ISSN
1432-2323 (Electronic)
ISSN-L
0364-2313
Publication state
Published
Issued date
05/2019
Peer-reviewed
Oui
Volume
43
Number
5
Pages
1207-1215
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
The present study aimed to assess the impact of perioperative fluid management on early acute kidney injury (AKI) rate and long-term sequelae in patients undergoing elective colorectal procedures within an enhanced recovery pathway (ERP).
Retrospective analysis of consecutive patients from a prospectively maintained ERP database (2011-2015) is performed. Pre- and postoperative creatinine levels (within 24 h) were compared according to risk (preoperative creatinine rise ×1.5), injury (×2), failure (×3), loss of kidney function and end-stage kidney disease (RIFLE) criteria. Risk factors for early AKI were identified through logistic regression analysis, and long-term outcome in patients with AKI was assessed.
Out of 7103 patients, 4096 patients (58%) with pre- and postoperative creatinine levels were included. Of these, 104 patients (2.5%) presented postoperative AKI. AKI patients received higher amounts of POD 0 fluids (3.8 ± 2.4 vs. 3.2 ± 2 L, p = 0.01) and had increased postoperative weight gain at POD 2 (6 ± 4.9 vs. 3 ± 2.7 kg, p = 0.007). Independent risk factors for AKI were high ASA score (ASA ≥ 3: OR 1.7; 95% CI 1.1-2.5), prolonged operating time (>180 min: OR 1.9; 95% CI 1.3-2.9) and diabetes mellitus (OR 2.5; 95% CI 1.5-4), while minimally invasive surgery was a protective factor (OR 0.6; 95% CI 0.4-0.9). Five patients (0.1%) developed chronic kidney disease, and two of them needed dialysis after a mean follow-up of 33.7 ± 22.4 months.
Early AKI was very uncommon in the present cohort of colorectal surgery patients treated within an ERP, and long-term sequelae were exceptionally low.
Keywords
Acute Kidney Injury/etiology, Acute Kidney Injury/therapy, Adult, Aged, Cohort Studies, Colon/surgery, Female, Fluid Therapy/methods, Follow-Up Studies, Humans, Male, Middle Aged, Operative Time, Perioperative Care/methods, Postoperative Complications/etiology, Postoperative Period, Rectum/surgery, Renal Dialysis, Retrospective Studies, Risk Factors
Pubmed
Web of science
Create date
01/03/2019 12:12
Last modification date
20/08/2019 15:10
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