Majör abdominal cerrahilerde akut böbrek hasarında perioperatif risk faktörleri

Abstract

Amaç: Akut böbrek hasarı (ABH), özellikle cerrahiye bağlı postoperatif bir komplikasyon olarak, bağımsız olarak morbidite ve mortalite ile ilişkilendirilmiştir. ABH ayrıca majör abdominal cerrahiden sonra da önemli oranda gelişir. Bu çalışmada, majör abdominal cerrahi sonrası ABH gelişimine sebep olan risk faktörlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışma retrospektif olarak planlandı. Çalışmaya majör abdominal cerrahi geçiren hastalar dahil edildi. Hasta dosyalarından hastaların demografik verileri, ameliyat öncesi laboratuvar verileri, ameliyat sırasındaki verileri ve ameliyat sonrası verileri kaydedildi. Postoperatif akut böbrek hasarının (PO-ABH) tanısı ve derecesi, KDIGO kılavuzlarına uygun olarak serum kreatinin ve/veya idrar çıkışı kriterleri ile değerlendirildi. Hastalar ABH olan ve ABH olmayan olmak üzere iki gruba ayrıldı. Bulgular: Verileri tam olan toplam 64 hasta çalışmaya dahil edildi. Bu hastaların 6'sında (%9.3) ABH gelişti. ABH grubunda yaş ortalaması istatistiksel olarak anlamlı derecede yüksek bulundu (p:0.043). Kırılganlık indeksi ABH grubunda anlamlı derecede yüksekti (p:0.020). Ayrıca ABH grubunda aspirin ve anjiyotensin dönüştürücü enzim inhibitörü (ACEI)/anjiyotensin reseptör blokeri (ARB) kullanımının istatistiksel olarak anlamlı düzeyde daha yüksek olduğu görüldü (sırasıyla p:0.022, p:0.044). Hastalar intraoperatif parametreler açısından değerlendirildiğinde ABH grubunda, kullanılan kolloid miktarı, kullanılan ES miktarı ve vazopressör kullanımı istatistiksel olarak anlamlı derecede yüksek bulundu (p:<0.001, p:0.036, p:0.022), sırasıyla). Son olarak ABH grubunda postoperatif dönemde vazopressör kullanımı ve diüretik kullanımı istatistiksel olarak anlamlı düzeyde yüksek bulundu (sırasıyla p:0.002, p:0.044). Sonuç: Perioperatif dönemi kapsayan birçok parametre PO-ABH'na neden olabilir. Özellikle yaşlı hastalarda kırılganlık ve yaş akılda tutulması gereken önemli faktörlerdir.

Keywords

• Abdominal cerrahi
• akut böbrek hasarı
• periopertif
• postoperatif
• risk faktörleri

Perioperative risk factors for acute kidney injury in major abdominal surgeries: a retrospective observatioal study

Abstract

Aims: Acute kidney injury (AKI), particularly as a postoperative complication related to surgery, has been independently associated with morbidity and mortality. AKI also develops at a significant rate after major abdominal surgery. In this study, it was aimed to identify the risk factors contributing to the development of AKI following major abdominal surgery. Methods: The study was retrospectively planned. Patients who underwent major abdominal surgery were included in the study. Patients’ demographic data, preoperative laboratory data, intraoperative data, and postoperative data were recorded from patient files. The diagnosis and severity of postoperative acute kidney injury (PO-AKI) were assessed using serum creatinine and/or urine output criteria in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The patients were divided into two groups: AKI and non-AKI. Results: A total of 64 patients with complete data were included in the study. Among these patients, 6 developed AKI (9.3%). The mean age in the AKI group was found to be statistically significantly higher (p: 0.043). The Frailty index was significantly higher in the AKI group (p: 0.020). Additionally, it was observed that the use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) was statistically significantly higher in the AKI group (p: 0.022, p: 0.044, respectively). When patients were evaluated in terms of intraoperative parameters, the amount of colloid used, the amount of ES used, and vasopressor usage were found to be statistically significantly higher in the AKI group (p<0.001, p: 0.036, p: 0.022, respectively). Lastly, vasopressor usage and diuretic usage were found to be statistically significantly higher in the AKI group for postoperative period (p: 0.002, p: 0.044, respectively) Conclusion: Many parameters covering the perioperative period can cause PO-AKI. Especially in elderly patients, frailty and age are significant factors that must be kept in mind.

Keywords

• Abdominal surgery
• acute kidney injury
• perioperative
• postoperative
• risk factors

References

1. O’Connor ME, Kirwan CJ, Pearse RM, Prowle JR. Incidence and associations of acute kidney injury after major abdominal surgery. Intens Care Med. 2016;42(4):521-30. doi: 10.1007/s00134-015-4157-7
2. Taşdemir Mecit BB. Retrospective investigation of acute kidney injury in postoperative patients in ICU. J Health Sci Med. 2023;6(4):725-729. doi: 10.32322/jhsm.1303802
3. Gameiro J, Fonseca JA, Neves M, Jorge S, Lopes JA. Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes. Ann Intensive Care. 2018;8(1):22. doi: 10.1186/s13613-018-0369-7
4. Weiss R, Saadat-Gilani K, Kerschke L, et al. Epidemiology of surgery-associated acute kidney injury (EPIS-AKI): study protocol for a multicentre, observational trial. BMJ Open. 2021;11(12):e055705. doi: 10.1136/bmjopen-2021-055705
5. Gameiro J, Fonseca JA, Marques F, Lopes JA. Management of acute kidney injury following major abdominal surgery: a contemporary review. J Clin Med. 2020;9(8):2679. doi: 10.3390/jcm9082679
6. Romagnoli S, Zagli G, Tuccinardi G, et al. Postoperative acute kidney injury in high-risk patients undergoing major abdominal surgery. J Crit Care. 2016;35:120-125. doi: 10.1016/j.jcrc.2016.05.012
7. Long TE, Helgason D, Helgadottir S, et al. Acute kidney injury after abdominal surgery: incidence, risk factors, and outcome. Anesth Analg. 2016;122(6):1912-1920. doi: 10.1213/ANE.0000000000001323
8. Zarbock A, Weiss R, Albert F, et al. Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study. Intens Care Med. 2023;49(12):1441-1455. doi: 10.1007/s00134-023-07169-7

9. Başkan S, Zengin M, Akçay M, Akçay Korkmaz F, Ceyhan E, Alagöz A. Evaluation of the effects of two different anesthesia methods on postoperative renal functions in geriatric patients undergoing hip fracture surgery; a prospective randomized trial. Anatolian Curr Med J. 2022;4(2);172-178. doi: 10.38053/acmj.1064942
10. Aydın E, Keserci Ö, Yılmaz Aydın F, Kadiroğlu AK. Evaluation of mortality and acute kidney injury by KDIGO and RIFLE in patients treated with colistin in the intensive care unit. J Health Sci Med. 2021;4(5):610-614. doi: 10.32322/jhsm.944502
11. Seoudy H, Al-Kassou B, Shamekhi J, et al. Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index. J Cachexia Sarcopenia Muscle. 2021;12(3):577-585. doi: 10.1002/jcsm.12689
12. Jian-Hui C, Iskandar EA, Cai SI, et al. Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer: a large cohort study in a single Chinese institution. Tumour Biol. 2016;37(3):3277-3283. doi: 10.1007/s13277-015-4008-8
13. Baldemir R, Eraslan Doğanay G, Cırık MÖ,et al. The relationship between acute physiology and chronic health evaluation-II, sequential organ failure assessment, Charlson comorbidity index and nutritional scores and length of intensive care unit stay of patients hospitalized in the intensive care unit due to chronic obstructive pulmonary disease. J Health Sci Med. 2022;5(5):1399-1404. doi: 10.32322/jhsm.1147178
14. Aykut A, Salman N. Poor nutritional status and frailty associated with acute kidney injury after cardiac surgery: a retrospective observational study. J Card Surg. 2022;37(12):4755-4761. doi: 10.1111/jocs.17134
15. Fagenson AM, Gleeson EM, Pitt HA, Lau KN. Albumin-bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg. 2020;230(4):637-645. doi: 10.1016/j.jamcollsurg.2019.12.007
16. Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. Crit Care. 2013;17(1):204. doi: 10.1186/cc11454
17. Polat EC, Koc A, Demirkan K. The role of the clinical pharmacist in the prevention of drug-induced acute kidney injury in the intensive care unit. J Clin Pharm Ther. 2022;47(12):2287-2294. doi: 10.1111/jcpt.13811
18. Himmelfarb J. Acute kidney injury in the elderly: problems and prospects. Semin Nephrol. 2009;29(6):658-664. doi: 10.1016/j.semnephrol.2009.07.008
19. Yüceler Kaçmaz H, Kahraman H, Gök M, Akın S, Sözüer E. The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study. J Health Sci Med. 2023;6(5):1133-1141. doi: 10.32322/jhsm.1350264
20. Jiesisibieke ZL, Tung TH, Xu QY, et al. Association of acute kidney injury with frailty in elderly population: a systematic review and meta-analysis. Ren Fail. 2019;41(1):1021-1027. doi: 10.1080/0886022X.2019.1679644
21. Messina A, Robba C, Calabrò L, et al. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Crit Care. 2021;25(1):43. doi: 10.1186/s13054-021-03464-1
22. Zazzara MB, Villani ER, Palmer K, et al. Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: results from the SHELTER study. Front Med (Lausanne). 2023;10:1091246. doi: 10.3389/fmed.2023.1091246
23. Roberts DJ, Smith SA, Tan Z, et al. Angiotensin-converting enzyme inhibitor/receptor blocker, diuretic, or nonsteroidal anti-inflammatory drug use after major surgery and acute kidney injury: a case-control study. J Surg Res. 2021;263:34-43. doi: 10.1016/j.jss.2021.01.019
24. Lee A, Cooper MG, Craig JC, Knight JF, Keneally JP. Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database Syst Rev. 2007;2007(2):CD002765. doi: 10.1002/14651858.CD002765.pub3
25. Yao L, Young N, Liu H, et al. Evidence for preoperative aspirin improving major outcomes in patients with chronic kidney disease undergoing cardiac surgery: a cohort study. Ann Surg. 2015;261(1):207-212. doi: 10.1097/SLA.0000000000000641
26. Aboul-Hassan SS, Stankowski T, Marczak J, et al. The use of preoperative aspirin in cardiac surgery: a systematic review and meta-analysis. J Card Surg. 2017;32(12):758-774. doi: 10.1111/jocs.13250
27. Hur M, Koo CH, Lee HC, et al. Preoperative aspirin use and acute kidney injury after cardiac surgery: a propensity-score matched observational study. PLoS One. 2017;12(5):e0177201. doi: 10.1371/journal.pone.0177201
28. Kendrick JB, Kaye AD, Tong Y, et al. Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S29-S34. doi: 10.4103/joacp.JOACP_26_18
29. Dubois MJ, Vincent IL. Colloid Fluids. In, Hahn RG, Prough DS, Svensen CH, eds. Perioperative Fluid Therapy. New York: Informa Healthcare: 2007:153-611.
30. De La Vega-Méndez FM, Estrada MI, Zuno-Reyes EE, et al. Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events. J Nephrol. 2024. doi: 10.1007/s40620-023-01859-7