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Risk factors for and the prevention of acute kidney injury after abdominal surgery

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Abstract

Postoperative acute kidney injury in patients undergoing abdominal surgery is not rare and often results in bad outcomes for patients. The incidence of postoperative acute kidney injury is hard to evaluate reliably due to its non-unified definitions in different studies. Risk factors for acute kidney injury specific to abdominal surgery include preoperative renal insufficiency, intraabdominal hypertension, blood transfusion, bowel preparation, perioperative dehydration, contrast agent and nephrotoxic drug use. Among these, preoperative renal insufficiency is the strongest predictor of acute kidney injury. The peri-operative management of high-risk patients should include meticulous selection of fluid solutions. Balanced crystalloid solutions and albumin are generally thought to be relatively safe, while the safety of hydroxyethyl starch solutions has been controversial. The purpose of the present review is to discuss the current knowledge regarding postoperative acute kidney injury in abdominal surgical settings to help surgeons make better decisions concerning the peri-operative management.

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References

  1. Kheterpal S, Tremper KK, Heung M, Rosenberg AL, Englesbe M, Shanks AM, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110:505–15.

    Article  PubMed  Google Scholar 

  2. Biteker M, Dayan A, Tekkesin AI, Can MM, Tayci I, Ilhan E, et al. Incidence, risk factors, and outcomes of perioperative acute kidney injury in noncardiac and nonvascular surgery. Am J Surg. 2014;207:53–9.

    Article  PubMed  Google Scholar 

  3. Kheterpal S, Tremper KK, Englesbe MJ, O’Reilly M, Shanks AM, Fetterman DM, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology. 2007;107:892–902.

    Article  PubMed  Google Scholar 

  4. Kim M, Brady JE, Li G. Variations in the risk of acute kidney injury across intraabdominal surgery procedures. Anesth Analg. 2014;119:1121–32.

    Article  PubMed  Google Scholar 

  5. Moghadamyeghaneh Z, Phelan MJ, Carmichael JC, Mills SD, Pigazzi A, Nguyen NT, et al. Preoperative dehydration increases risk of postoperative acute renal failure in colon and rectal surgery. J Gastrointest Surg. 2014;18:2178–85.

    Article  PubMed  Google Scholar 

  6. Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. 2009;13:R79.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Slankamenac K, Breitenstein S, Held U, Beck-Schimmer B, Puhan MA, Clavien PA. Development and validation of a prediction score for postoperative acute renal failure following liver resection. Ann Surg. 2009;250:720–8.

    Article  PubMed  Google Scholar 

  8. Licker M, Cartier V, Robert J, Diaper J, Villiger Y, Tschopp JM, et al. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery. Ann Thorac Surg. 2011;91:844–50.

    Article  PubMed  Google Scholar 

  9. Kim CS, Oak CY, Kim HY, Kang YU, Choi JS, Bae EH, et al. Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer. PLoS One. 2013;8:e82289.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Slankamenac K, Beck-Schimmer B, Breitenstein S, Puhan MA, Clavien PA. Novel prediction score including pre- and intraoperative parameters best predicts acute kidney injury after liver surgery. World J Surg. 2013;37:2618–28.

    Article  PubMed  Google Scholar 

  11. Thakar CV, Kharat V, Blanck S, Leonard AC. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol. 2013;13:56–56.

    Google Scholar 

  12. Cho E, Kim SC, Kim MG, Jo SK, Cho WY, Kim HK. The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study. BMC Nephrol. 2014;15:169.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zhang J, Feng G, Yang Y, Zhang P, Pu C, Zhao G. Acute kidney injury after radical gastrectomy: a single center study. Int Urol Nephrol. 2014;46:973–7.

    Article  CAS  PubMed  Google Scholar 

  14. Kambakamba P, Slankamenac K, Tschuor C, Kron P, Wirsching A, Maurer K, et al. Epidural analgesia and perioperative kidney function after major liver resection. Br J Surg. 2015;102:805–12.

    Article  CAS  PubMed  Google Scholar 

  15. Tomozawa A, Ishikawa S, Shiota N, Cholvisudhi P, Makita K. Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study. Can J Anaesth. 2015;62:753–61.

    Article  PubMed  Google Scholar 

  16. Causey MW, Maykel JA, Hatch Q, Miller S, Steele SR. Identifying risk factors for renal failure and myocardial infarction following colorectal surgery. J Surg Res. 2011;170:32–7.

    Article  PubMed  Google Scholar 

  17. STARSurg Collaborative. Outcomes After Kidney injury in Surgery (OAKS): protocol for a multicentre, observational cohort study of acute kidney injury following major gastrointestinal and liver surgery. BMJ Open. 2016;6:e009812.

    Article  PubMed Central  Google Scholar 

  18. Eknoyan G. Emergence of the concept of acute renal failure. Am J Nephrol. 2002;22:225–30.

    Article  PubMed  Google Scholar 

  19. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, w. Acute Dialysis Quality Initiative. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter. Suppl. 2012; 2:1–138.

  22. Ozrazgat-Baslanti T, Thottakkara P, Huber M, Berg K, Gravenstein N, Tighe P, et al. Acute and chronic kidney disease and cardiovascular mortality after major surgery. Ann Surg. 2016;264:987–96.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009;249:851–8.

    Article  PubMed  Google Scholar 

  24. Sharma SK, McCauley J, Cottam D, Mattar SG, Holover S, Dallal R, et al. Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis. 2006;2:389–92.

    Article  PubMed  Google Scholar 

  25. Masoomi H, Carmichael JC, Dolich M, Mills S, Ketana N, Pigazzi A, et al. Predictive factors of acute renal failure in colon and rectal surgery. Am Surg. 2012;78:1019–23.

    PubMed  Google Scholar 

  26. Eilers H, Liu KD, Gruber A, Niemann CU. Chronic kidney disease: implications for the perioperative period. Minerva Anestesiol. 2010;76:725–36.

    CAS  PubMed  Google Scholar 

  27. De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E. Intra-abdominal hypertension and abdominal compartment syndrome. Am J Kidney Dis. 2011;57:159–69.

    Article  PubMed  Google Scholar 

  28. Villa G, Samoni S, De Rosa S, Ronco C. The pathophysiological hypothesis of kidney damage during intra-abdominal hypertension. Front Physiol. 2016;7:55.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N. Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensiv Care Med. 2008;34:707–13.

    Article  Google Scholar 

  30. Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K. Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg. 1995;82:235–8.

    Article  CAS  PubMed  Google Scholar 

  31. Demarchi AC, de Almeida CT, Ponce D, Castro MCE, Danaga AR, Yamaguti FA, et al. Intra-abdominal pressure as a predictor of acute kidney injury in postoperative abdominal surgery. Ren Fail. 2014;36:557–61.

    Article  PubMed  Google Scholar 

  32. Biancofiore G, Bindi ML, Romanelli AM, Bisa M, Boldrini A, Consani G, et al. Postoperative intra-abdominal pressure and renal function after liver transplantation. Arch Surg. 2003;138:703–6.

    Article  PubMed  Google Scholar 

  33. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33:315–22.

    Article  PubMed  Google Scholar 

  34. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensiv Care Med. 2007;33:951–62.

    Article  Google Scholar 

  35. Joshi G, Cunningham A. Anesthesia for laparoscopic and robotic surgeries. In: Cullen B, Barash PB, Stoelting RK, Cahalan MK, Stock MC, Ortega R, editors. Clinical anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 1257–73.

    Google Scholar 

  36. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6.

    Article  PubMed  Google Scholar 

  37. STARSurg Collaborative. Impact of postoperative non-steroidal anti-inflammatory drugs on adverse events after gastrointestinal surgery. Br J Surg. 2014;101:1413–23.

    Article  Google Scholar 

  38. Winkelmayer WC, Waikar SS, Mogun H, Solomon DH. Nonselective and cyclooxygenase-2-selective NSAIDs and acute kidney injury. Am J Med. 2008;121:1092–8.

    Article  CAS  PubMed  Google Scholar 

  39. Chou CI, Shih CJ, Chen YT, Ou SM, Yang CY, Kuo SC, et al. Adverse effects of oral nonselective and cyclooxygenase-2-Selective NSAIDs on hospitalization for acute kidney injury: a nested case-control cohort study. Medicine (Baltimore). 2016;95:e2645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Ungprasert P, Cheungpasitporn W, Crowson CS, Matteson EL. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: a systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26:285–91.

    Article  CAS  PubMed  Google Scholar 

  41. Lapi F, Azoulay L, Yin H, Nessim SJ, Suissa S. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ. 2013;346:e8525.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Elyasi S, Khalili H, Dashti-Khavidaki S, Mohammadpour A. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review. Eur J Clin Pharmacol. 2012;68:1243–55.

    Article  CAS  PubMed  Google Scholar 

  43. Carreno JJ, Kenney RM, Lomaestro B. Vancomycin-associated renal dysfunction: where are we now? Pharmacotherapy. 2014;34:1259–68.

    Article  CAS  PubMed  Google Scholar 

  44. Rudnick MR, Goldfarb S, Tumlin J. Contrast-induced nephropathy: is the picture any clearer? Clin J Am Soc Nephrol. 2008;3:261–2.

    Article  PubMed  Google Scholar 

  45. Hurst FP, Bohen EM, Osgard EM, Oliver DK, Das NP, Gao SW, et al. Association of oral sodium phosphate purgative use with acute kidney injury. J Am Soc Nephrol. 2007;18:3192–8.

    Article  CAS  PubMed  Google Scholar 

  46. Choi NK, Lee J, Chang Y, Kim YJ, Kim JY, Song HJ, et al. Acute renal failure following oral sodium phosphate bowel preparation: a nationwide case-crossover study. Endoscopy. 2014;46:465–70.

    Article  PubMed  Google Scholar 

  47. Khurana A, McLean L, Atkinson S, Foulks CJ. The effect of oral sodium phosphate drug products on renal function in adults undergoing bowel endoscopy. Arch Intern Med. 2008;168:593–7.

    Article  CAS  PubMed  Google Scholar 

  48. Heher EC, Thier SO, Rennke H, Humphreys BD. Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation. Clin J Am Soc Nephrol. 2008;3:1494–503.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Choi NK, Chang Y, Jung SY, Choi YK, Lee J, Lee JH, et al. A population-based case-crossover study of polyethylene glycol use and acute renal failure risk in the elderly. World J Gastroenterol. 2011;17:651–6.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Choi NK, Lee J, Chang Y, Jung SY, Kim YJ, Lee SM, et al. Polyethylene glycol bowel preparation does not eliminate the risk of acute renal failure: a population-based case-crossover study. Endoscopy. 2013;45:208–13.

    Article  CAS  PubMed  Google Scholar 

  51. Layton JB, Klemmer PJ, Christiansen CF, Bomback AS, Baron JA, Sandler RS, et al. Sodium phosphate does not increase risk for acute kidney injury after routine colonoscopy, compared with polyethylene glycol. Clin Gastroenterol Hepatol. 2014;12(1514–21):e3.

    Google Scholar 

  52. Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth. 2015;115 (Suppl 2):ii3–ii14.

  53. Golden D, Corbett J, Forni LG. Peri-operative renal dysfunction: prevention and management. Anaesthesia. 2016;71(Suppl 1):51–7.

    Article  PubMed  Google Scholar 

  54. Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA. Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol. 2012;13:101.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Karkouti K, Wijeysundera DN, Yau TM, McCluskey SA, Chan CT, Wong PY, et al. Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. Anesthesiology. 2012;116:613–21.

    Article  CAS  PubMed  Google Scholar 

  56. Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256:18–24.

    Article  PubMed  Google Scholar 

  57. Nadeem A, Salahuddin N, El Hazmi A, Joseph M, Bohlega B, Sallam H, et al. Chloride-liberal fluids are associated with acute kidney injury after liver transplantation. Crit Care. 2014;18:625.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte. Ann Surg. 2012;255:821–9.

    Article  PubMed  Google Scholar 

  59. Serrano AB, Candela-Toha AM, Zamora J, Vera J, Muriel A, Del Rey JM, et al. Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery: a randomised controlled trial. Eur J Anaesthesiol. 2016;33:436–43.

    Article  PubMed  Google Scholar 

  60. Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367:1901–11.

    Article  CAS  PubMed  Google Scholar 

  61. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367:124–34.

    Article  CAS  PubMed  Google Scholar 

  62. Reinhart K, Perner A, Sprung CL, Jaeschke R, Schortgen F, Johan Groeneveld AB, et al. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensiv Care Med. 2012;38:368–83.

    Article  CAS  Google Scholar 

  63. Kashy BK, Podolyak A, Makarova N, Dalton JE, Sessler DI, Kurz A. Effect of hydroxyethyl starch on postoperative kidney function in patients having noncardiac surgery. Anesthesiology. 2014;121:730–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Martin C, Jacob M, Vicaut E, Guidet B, Van Aken H, Kurz A. Effect of waxy maize-derived hydroxyethyl starch 130/0.4 on renal function in surgical patients. Anesthesiology. 2013;118:387–94.

    Article  CAS  PubMed  Google Scholar 

  65. Endo A, Uchino S, Iwai K, Saito K, Sanui M, Takinami M, et al. Intraoperative hydroxyethyl starch 70/0.5 is not related to acute kidney injury in surgical patients: retrospective cohort study. Anesth Analg. 2012;115:1309–14.

    Article  CAS  PubMed  Google Scholar 

  66. Gillies MA, Habicher M, Jhanji S, Sander M, Mythen M, Hamilton M, et al. Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis. Br J Anaesth. 2014;112:25–34.

    Article  CAS  PubMed  Google Scholar 

  67. Hartog CS, Natanson C, Sun J, Klein HG, Reinhart K. Concerns over use of hydroxyethyl starch solutions. BMJ. 2014;349:g5981.

    Article  PubMed  PubMed Central  Google Scholar 

  68. The SSI. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.

    Article  Google Scholar 

  69. Sedrakyan A, Gondek KD, Elefteriades JA. Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery. Chest. 2003;123:1853–7.

    Article  PubMed  Google Scholar 

  70. Xing XZ, Wang HJ, Huang CL, Yang QH, Qu SN, Zhang H, et al. Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery. World J Emerg Med. 2012;3:278–81.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Gastroenterological Surgery, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People’s Republic of China

    Yongbo An, Kai Shen & Yingjiang Ye

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Correspondence to Kai Shen.

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Yongbo An, Kai Shen and Yingjiang Ye have no conflicts of interest or financial ties to disclose.

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An, Y., Shen, K. & Ye, Y. Risk factors for and the prevention of acute kidney injury after abdominal surgery. Surg Today 48, 573–583 (2018). https://doi.org/10.1007/s00595-017-1596-5

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