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Acute Kidney Injury After Major Abdominal Surgery: Epidemiology and Management Challenges

Chapter

Abstract

Of all the cases of AKI during acute care hospitalization, up to 40 % are observed in the perioperative settings. AKI after major abdominal surgery, although less frequent than cardiovascular surgical settings, similarly leads to increased morbidity and high mortality. The present chapter discusses patient-related, intraoperative and postoperative factors that are linked with AKI and are unique to this surgical setting. Present AKI care in hospitals represents a poorly coordinated effort, and a multidisciplinary management algorithm that encompasses perioperative risk scoring, early detection, elimination of aggravating factors, and early input from renal specialists may improve clinical outcomes. Following development of AKI after abdominal surgery, several strategies, including the use of a chloride-restrictive parenteral fluid, can prove to be reno-protective and result in improved surgical outcomes.

Keywords

Acute Kidney Injury Major Abdominal Surgery Noncardiac Surgery Kidney Disease Improve Global Outcome Parenteral Fluid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Competing Interests

SA has received educational support and travel bursaries from Baxter Healthcare and Fresenius Kabi. DNL has received research funding and speaker’s honoraria from BBraun, Fresenius Kabi, and Baxter Healthcare.

Funding

No external funding was received for this article.

References

  1. 1.
    Thakar CV. Perioperative acute kidney injury. Adv Chronic Kidney Dis. 2013;20:67–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Weingarten TN, Gurrieri C, McCaffrey JM, et al. Acute kidney injury following bariatric surgery. Obes Surg. 2013;23:64–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Kolhe NV, Stevens PE, Crowe AV, et al. Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme database. Crit Care. 2008;12 Suppl 1:S2.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Abelha FJ, Botelho M, Fernandes V, Barros H. Outcome and quality of life of patients with acute kidney injury after major surgery. Nefrologia. 2009;29:404–14.PubMedGoogle Scholar
  5. 5.
    Borthwick E, Ferguson A. Perioperative acute kidney injury: risk factors, recognition, management, and outcomes. BMJ. 2010;341:c3365.PubMedCrossRefGoogle Scholar
  6. 6.
    Metcalfe W, Simpson M, Khan IH, et al. Acute renal failure requiring renal replacement therapy: incidence and outcome. QJM. 2002;95:579–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Bihorac A, Yavas S, Subbiah S, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009;249:851–8.PubMedCrossRefGoogle Scholar
  8. 8.
    National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Adding insult to injury: a review of the care of patients who died in hospital with a primary diagnosis of acute kidney injury (acute renal failure). Available at. http://www.ncepod.org.uk/2009report1/Downloads/AKI_report.pdf. Accessed 3 Aug 2013
  9. 9.
    Kelz RR, Reinke CE, Zubizarreta JR, et al. Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study. Ann Surg. 2013;258:359–63.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kheterpal S, Tremper KK, Heung M, 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.CrossRefGoogle Scholar
  12. 12.
    Lobo DN, Dube MG, Neal KR, et al. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clin Nutr. 2001;20:125–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Awad S, Allison SP, Lobo DN. Fluid and electrolyte balance: the impact of goal directed teaching. Clin Nutr. 2008;27:473–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Awad S, Allison SP, Lobo DN. The history of 0.9 % saline. Clin Nutr. 2008;27:179–88.PubMedCrossRefGoogle Scholar
  15. 15.
    Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Shaw AD, Bagshaw SM, Goldstein SL, 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Powell-Tuck J, Gosling P, Lobo DN et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP). The British Association for Parenteral and Enteral Nutrition (BAPEN). 2008. http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf. Accessed 21 Feb 2014
  18. 18.
    Hansen PB, Jensen BL, Skott O. Chloride regulates afferent arteriolar contraction in response to depolarization. Hypertension. 1998;32:1066–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71: 726–35.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    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® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256: 18–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Lobo DN, Awad S. Should chloride-rich crystalloids remain the main stay of fluid resuscitation to prevent “pre-renal” acute kidney injury? Con. Kidney Int. 2014, Apr 9. doi:  10.1038/ki.2014.105. [Epub ahead of print].

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research UnitQueen’s Medical CentreNottinghamUK
  2. 2.Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research UnitNottingham University Hospitals, Queen’s Medical CentreNottinghamUK

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