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Epidemiological characteristics of and risk factors for patients with postoperative acute kidney injury: a multicenter prospective study in 30 Chinese intensive care units

  • Nephrology - Original Paper
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Abstract

Background

Although there were studies to investigate the risk factors for acute kidney injury (AKI) after surgery, most of them focused on one specific type of surgeries. The risk factors for postoperative AKI in patients undergoing all surgeries in intensive care units (ICU) have not been reported.

Methods

Data from 1731 patients undergoing surgery in 30 ICUs of 28 tertiary hospitals in Beijing from March to August 2012 were prospectively collected. AKI was defined and staged by the KDIGO criteria. Multivariate logistic regression analysis was performed to assess independent risk factors for postoperative AKI.

Results

Postoperative AKI occurred in 44.8% of patients (stage 1 54.8%; stage 2 21.9%, stage 3 23.3%). Cardiovascular surgery was identified as an independent factor for postoperative AKI as well as emergency surgery [odds ratio (OR) 1.403], nephrotoxic drugs (OR 1.303), APACHE II score (OR 1.055), SOFA score (OR 1.115), duration for positive fluid balance (OR 1.165), use of diuretics (OR 2.293), sepsis (OR 1.501), and CKD (OR 4.517). AKI stage 3 versus stages 1–2 was associated with higher mortality in ICU, hospital, and 28-day follow-up after cardiovascular, abdominal, limb, and chest surgeries, while this was not observed after neurosurgery or other surgeries.

Conclusion

Risk factors for AKI in ICU patients after different types of surgery were identified. This might be the first step to reduce the high incidence of AKI after surgery. The presence of AKI in ICU patients was associated with higher mortality after most types of surgery, but not after neurosurgery.

Trial registration

ChiCTR-ONC-11001875.

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Abbreviations

AKI:

Acute kidney injury

ICU:

Intensive care unit

RRT:

Renal replacement therapy

KDIGO:

Kidney Disease: Improving Global Outcomes

SCr:

Serum creatinine

GFR:

Glomerular filtration rate

MDRD:

Modification of diet in renal disease

ACCP/SCCM:

American College of Chest Physicians and the Society of Critical Care Medicine

ICD:

International classification of diseases

BMI:

Body mass index

CKD:

Chronic kidney disease

DIC:

Disseminated intravascular coagulation

APACHE:

Acute Physiology and Chronic Health Evaluation

SOFA:

Sequential Organ Failure Assessment

SD:

Standard deviation

IQR:

Interquartile range

OR:

Odds ratio

CI:

Confidence interval

NYHA:

New York Heart Association

ENT:

Ears, nose, and throat

MAP:

Mean arterial pressure

CHF:

Congestive heart failure

MODS:

Multiple organ dysfunction syndrome

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Acknowledgments

The study was supported by a grant from the Beijing Municipal Science & Technology Commission, a government fund used to improve healthcare quality (No. D101100050010058). It offered financial support for data collection. Also, in the final revision stage of the essay, I would like to thank Yanling Hu who added a lot of valuable suggestions and guidance.

Funding

Funding

This study was funded by a grant from the Beijing Municipal Science & Technology Commission, a government fund used to improve healthcare quality (No. D101100050010058).

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, 100038, China

    Yu Zhang, Li Jiang & Xiuming Xi

  2. Department of Intensive Care Units, Tangshan People’s Hospital, Tangshan, 063000, China

    Yu Zhang & Baomin Wang

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  1. Yu Zhang
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  2. Li Jiang
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  3. Baomin Wang
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  4. Xiuming Xi
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Contributions

Author contribution

YZ designed and carried out the study, performed the statistical analysis, and drafted the manuscript. LJ was involved in design and in acquisition of data and helped to revise the manuscript critically for important content. WB checked the whole data. The Beijing Acute Kidney Injury Trial (BAKIT) Workgroup participated in acquisition and interpretation of data. XX conceived of the study, participated in its design, and helped to revise manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiuming Xi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Availability of data and material

The datasets generated during the current study are available in the Beijing Acute Kidney Injury Trial (BAKIT) workgroup repository.

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All individual participants included in the study consent for publication.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Zhang, Y., Jiang, L., Wang, B. et al. Epidemiological characteristics of and risk factors for patients with postoperative acute kidney injury: a multicenter prospective study in 30 Chinese intensive care units. Int Urol Nephrol 50, 1319–1328 (2018). https://doi.org/10.1007/s11255-018-1828-7

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