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

July 20, 2023

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, diabe‑ tes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and amino‑ glycosides 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.
Keywords
Acute kidney injury, Epidemiology, Postoperative, Mortality, Perioperative