Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Meersch, Melanie; Weiss, Raphael; Strauß, Christian; Albert, Felix; Booke, Hendrik; Forni, Lui; Pittet, Jean-Francois; Kellum, John A.; Rosner, Mitchell; Mehta, Ravindra; Bellomo, Rinaldo; Rosenberger, Peter; Zarbock, Alexander; Makhloufi, Hichem; Sakhraoui, Rachida; Ouyahia, Amel; Rais, Mounira; Kouicem, Aya Tinhinane; Derwish, Khawla; Abdoun, Meriem; Ouahab, Ilhem; Bouaoud, Souad; Tidjane, Anisse; Pérez Rivera, Carlos Jose; García, Juan Pablo; Peng, Ke; Ji, Fu-Hai; Ma, Zheng-Min; Elbahnasawy, Mohamed Gamal; Elsalhawy, Shady; Nafea, Ahmed Mahmoud; Osman, Nermin A.; Emara, Moataz Maher; Bonna, Mohamed Mamdouh; Abdehaleem, Ibrahim Abdelmonaem; Abbas, Ahmed Mohamed; Abbas, Mostafa Samy; Esmaeil, Hany Mostafa; Joannes-Boyau, Oliver; Legros, Vincent; Floch, Thierry; Muccio, Salvatore; Menage-Innocenti, Lison; Brochet, Benjamin; Leclercq-Rouget, Marion; Geneve, Claire; Mocarquer, Bernardita Valenzuela; Aveline, Christophe; Vautier, Pierre; Nadaud, Julien; Rimmelé, Thomas; Cerro, Valérie; Suria, Stéphanie; Elmawieh, Jamie; El-Jawiche, Rita; Cirenei, Cédric; Lebuffe, Gilles; Ponsonnard, Sébastien; Egreteau, Pierre-Yves; Ichai, Carole; Jean-Michel, Vanessa; Léger, Maxime; Lasocki, Sigismond; Masson, Charline; Rineau, Emmanuel; Cassisa, Viviane; Verrier, Pierre; Atchade, Enora; Rochon, Charles-Edouard; Quentin, Vidal; Queixalos, Nina; Braun, Thierry; Grand, Hubert; Mayeur, Nicolas; Pasquie, Marie; Garçon, Pierre; Bruckert, Vincent; Pradel, Gaël; Ramorasata, Andersen; Ravry, Céline; Mottard, Nicolas; von Groote, Thilo; Dörr, Christian; Küllmar, Mira; Massoth, Christina; Motekallemi, Arash; Saadat-Gilani, Khaschayar; Kerschke, Laura; Storck, Michael; Varghese, Julian; Wempe, Carola; Grüßer, Linda; Kowark, Ana; Brandenburger, Timo; Hohn, Andreas; Häberle, Helene; Hofmann, Pascal; Kuhle, Jonathan; Calov, Stefanie; Bernard, Alice Marie; Mirakaj, Valbona; Weber, Kathrin; Pfister, Kathrin; Stetz, Lena; Müller, Sarah Dorothea; Klaus, Stephan; Sadlo, Marco; Sengelhoff, Christian; Stenger, Carina-Kristin; Göbel, Ulrich; Heringlake, Matthias; Arnaoutoglou, Eleni; Stratigopoulou, Panagiota; Danai, Pantazi; Dimakopoulou, Antonia; Menis, Apostolos-Alkiviadis; Ioannidis, Orestis; Jalaawiy, Humam; Anwar, Aeshah; Hashim, Hashim Talib; Rasheed Aldawoody, Hogir Imad; Cortegiani, Andrea; Ippolito, Mariachiara; Marino, Claudia; Presti, Gabriele; Fricano, Dario Calogero; De Rosa, Silvia; Bianchin, Andrea; Paternoster, Gianluca; Fasciano, Umberto; Cutuli, Salvatore Lucio; Savino, Spadaro; Enrico, Bussolati; Marco, Palmieri; Alberto, Volta Carlo; Tripodi, Vincenzo Francesco; Fiume, Diego; Iuorio, Angela; Santorsola, Clemente; Abu-Hussein, Bilal; Hasanein, Khaled; Shin, Seokyung; Baek, Jongyoon; Kim, Sehui; Elhadi, Muhammed; Aldressi, Wafa; Abuzeid, Issa A.; Albaraesi, Mohammed N.; Moftah, Mohamed Aziz; Aldressi, Sarah; Khalel, Wegdan; Abdulwahed, Eman; Ali Alshareea, Entisar Ahmed; Abujrad Reem Ghmagh, Akram Abdulhamid Ashur; Biala, Marwa Isa; Benjouira, Rayet Al Islam; Aliwa, Mohamed; Msherghi, Ahmed; Tuwaib, Ahmed; Mustafa, Tahani; Zriba, Haifa; Agilla, Hamza Mahmoud; Sadek Ben Hamida, Bahaeddin Taher; Mohamed Otman, Rema Hassan; Mijovska, Maja Mojsova; Podesta, Anne Marie Camilleri; Gasca López, Gilberto Adrián; Amro, Sarah; de Freitas Regufe, Rita; Grigoryev, Evgeny; Ivkin, Artem; Balakhnin, Dmitriy; Shukevich, Dmitriy; Yaroustovsky, Michael; Barmou, Abdulnaser; Kaserer, Alexander; Castellucci, Clara; Akbas, Samira; Petrun, Andreja Möller; Gregorcic, Irena; Sok, Vesna; Links, Andre; Barreto, Elizabeth Bárcena; Melchor, Javier Ripollés; Becerra-Bolaños, Ángel; Rodríguez-Pérez, Aurelio; Estévez, Javier Mata; Matas, Juan Mulet; Palao, Sara Pérez; Álvarez, Mercedes García; Albadalejo, Albert Bainac; González, Astrid Batalla; Caro, Ana María Gómez; Blanco, Ignacio Hinojal; Fernandez, Diego Toral; Perez, Gracia Herranz; Ejea, Margarita Logroño; de la Rosa Ruiz, Noelia; Abasolo, María Gastaca; Ferreira, Lourdes; Lobato, Félix; Sevilla, Marta Aguado; Erazo, Andres; Paulis, Berta Castellano; de la Calle Gil, Isabel; Adamove, Peter; Blasco, Francho Miguel Blasco; García-Sánchez, Jose Ignacio; Zamorano, Sara García; Herreros, Natalia Gijón; Callejas, Raquel; Gómez, Mercedes Estaire; Candela-Toha, Angel M.; Claros-Llamas, Elisabeth; Cobeta-Orduña, Pilar; Crespo-Aliseda, Pascual; Dorado-Díaz, Trinidad; Gómez-Rojo, María; Mané-Ruiz, M. Nuria; González, M. Carmen Martín-; Martínez-Pérez, Adolfo; Tiscar, Carlos; Menéndez, Patricia Galán; Calvo, Verónica Estepa; Espí, Laura Llinares; Aldeán, Yuri Santiago Loaiza; Ariza, Víctor Morales; Vila, Laura Villarino; García-Miguel, Francisco Javier; Suliman, Elfayadh S. M.; Ibrahim, Ahmed Mohamed; Fadlalmola, Hammad Ali.; Swed, Sarya; Wu, Vin-Cent; Orhan-Sungur, Mukadder; Altun, Demet; Canbolat, Nur; Dinçer, Müşerref Beril; Yildirim, Serap Aktas; Iyigun, Muzeyyen; Yapıcı, Davud; Özdemir, Levent; Sagün, Aslınur; Boztug, Neval; Gündüz, Emel; Lafli-Tunay, Demet; Karakaya, Deniz; Dost, Burhan; Komurcu, Ozgur; Dilmen, Ozlem Korkmaz; Akcil, Eren Fatma; Tunali, Yusuf; Ok, Gulay; Tok-Alsina, Eda; Polat, Cengiz; Kızılcık, Nurcan; Şen, Öznur; Darçın, Kamil; Uğur, Semra; Gürkan, Yavuz; Saracoglu, Kemal Tolga; Yıldız-Koyuncu, Özge; Demir, Z. Aslı; Postacı, N. Aysun; Özgök, Ayşegül; Karadeniz, Ümit; Özay, Hülya Yiğit; Balcı, Eda; Salman, Nevriye; Girgin, Behiç; Sagir, Ozlem; Demir, Hafize Fisun; Ugun, Fatih; Toprak, Hüseyin İlksen; Özcan, Mustafa Soner; Alkaya-Solmaz, Filiz; Yilmaz, Mehmet; Karaca, Umran; Şahin, Sevtap Hekimoglu; Erkoç, Süheyla Karadağ; Alkış, Neslihan; Baytaş, Volkan; Erturk, Engin; Saylan, Sedat; Akdogan, Ali; Yeşil, Beyza Büyükgebiz; Boran, Omer Faruk; Orak, Yavuz; Çalişir, Feyza; Büyükçoban, Sibel; Kuvaki, Bahar; Cansabuncu, Seda; Akesen, Selcan; Gören, Suna; Yeniocak, Tugce; Orman, Osman; Karka, Özlem Ersoy; Sahin, Tulay; Momot, Natalia; Panchenko, Anna; Rutledge, Kristen

doi:10.1007/s00134-023-07314-2

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Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Authors: Meersch, Melanie ; Weiss, Raphael ; Strauß, Christian ; Albert, Felix ; Booke, Hendrik ; Forni, Lui ; Pittet, Jean-Francois ; Kellum, John A. ; Rosner, Mitchell ; Mehta, Ravindra ; Bellomo, Rinaldo ; Rosenberger, Peter ; Zarbock, Alexander ; Makhloufi, Hichem ; Sakhraoui, Rachida ; Ouyahia, Amel ; Rais, Mounira ; Kouicem, Aya Tinhinane ; Derwish, Khawla ; Abdoun, Meriem ; Ouahab, Ilhem ; Bouaoud, Souad ; Tidjane, Anisse ; Pérez Rivera, Carlos Jose ; García, Juan Pablo ; Peng, Ke ; Ji, Fu-Hai ; Ma, Zheng-Min ; Elbahnasawy, Mohamed Gamal ; Elsalhawy, Shady ; Nafea, Ahmed Mahmoud ; Osman, Nermin A. ; Emara, Moataz Maher ; Bonna, Mohamed Mamdouh ; Abdehaleem, Ibrahim Abdelmonaem ; Abbas, Ahmed Mohamed ; Abbas, Mostafa Samy ; Esmaeil, Hany Mostafa ; Joannes-Boyau, Oliver ; Legros, Vincent ; Floch, Thierry ; Muccio, Salvatore ; Menage-Innocenti, Lison ; Brochet, Benjamin ; Leclercq-Rouget, Marion ; Geneve, Claire ; Mocarquer, Bernardita Valenzuela ; Aveline, Christophe ; Vautier, Pierre ; Nadaud, Julien ; Rimmelé, Thomas ; Cerro, Valérie ; Suria, Stéphanie ; Elmawieh, Jamie ; El-Jawiche, Rita ; Cirenei, Cédric ; Lebuffe, Gilles ; Ponsonnard, Sébastien ; Egreteau, Pierre-Yves ; Ichai, Carole ; Jean-Michel, Vanessa ; Léger, Maxime ; Lasocki, Sigismond ; Masson, Charline ; Rineau, Emmanuel ; Cassisa, Viviane ; Verrier, Pierre ; Atchade, Enora ; Rochon, Charles-Edouard ; Quentin, Vidal ; Queixalos, Nina ; Braun, Thierry ; Grand, Hubert ; Mayeur, Nicolas ; Pasquie, Marie ; Garçon, Pierre ; Bruckert, Vincent ; Pradel, Gaël ; Ramorasata, Andersen ; Ravry, Céline ; Mottard, Nicolas ; von Groote, Thilo ; Dörr, Christian ; Küllmar, Mira ; Massoth, Christina ; Motekallemi, Arash ; Saadat-Gilani, Khaschayar ; Kerschke, Laura ; Storck, Michael ; Varghese, Julian ; Wempe, Carola ; Grüßer, Linda ; Kowark, Ana ; Brandenburger, Timo ; Hohn, Andreas ; Häberle, Helene ; Hofmann, Pascal ; Kuhle, Jonathan ; Calov, Stefanie ; Bernard, Alice Marie ; Mirakaj, Valbona ; Weber, Kathrin ; Pfister, Kathrin ; Stetz, Lena ; Müller, Sarah Dorothea ; Klaus, Stephan ; Sadlo, Marco ; Sengelhoff, Christian ; Stenger, Carina-Kristin ; Göbel, Ulrich ; Heringlake, Matthias ; Arnaoutoglou, Eleni ; Stratigopoulou, Panagiota ; Danai, Pantazi ; Dimakopoulou, Antonia ; Menis, Apostolos-Alkiviadis ; Ioannidis, Orestis ; Jalaawiy, Humam ; Anwar, Aeshah ; Hashim, Hashim Talib ; Rasheed Aldawoody, Hogir Imad ; Cortegiani, Andrea ; Ippolito, Mariachiara ; Marino, Claudia ; Presti, Gabriele ; Fricano, Dario Calogero ; De Rosa, Silvia ; Bianchin, Andrea ; Paternoster, Gianluca ; Fasciano, Umberto ; Cutuli, Salvatore Lucio ; Savino, Spadaro ; Enrico, Bussolati ; Marco, Palmieri ; Alberto, Volta Carlo ; Tripodi, Vincenzo Francesco ; Fiume, Diego ; Iuorio, Angela ; Santorsola, Clemente ; Abu-Hussein, Bilal ; Hasanein, Khaled ; Shin, Seokyung ; Baek, Jongyoon ; Kim, Sehui ; Elhadi, Muhammed ; Aldressi, Wafa ; Abuzeid, Issa A. ; Albaraesi, Mohammed N. ; Moftah, Mohamed Aziz ; Aldressi, Sarah ; Khalel, Wegdan ; Abdulwahed, Eman ; Ali Alshareea, Entisar Ahmed ; Abujrad Reem Ghmagh, Akram Abdulhamid Ashur ; Biala, Marwa Isa ; Benjouira, Rayet Al Islam ; Aliwa, Mohamed ; Msherghi, Ahmed ; Tuwaib, Ahmed ; Mustafa, Tahani ; Zriba, Haifa ; Agilla, Hamza Mahmoud ; Sadek Ben Hamida, Bahaeddin Taher ; Mohamed Otman, Rema Hassan ; Mijovska, Maja Mojsova ; Podesta, Anne Marie Camilleri ; Gasca López, Gilberto Adrián ; Amro, Sarah ; de Freitas Regufe, Rita ; Grigoryev, Evgeny ; Ivkin, Artem ; Balakhnin, Dmitriy ; Shukevich, Dmitriy ; Yaroustovsky, Michael ; Barmou, Abdulnaser ; Kaserer, Alexander ; Castellucci, Clara ; Akbas, Samira ; Petrun, Andreja Möller ; Gregorcic, Irena ; Sok, Vesna ; Links, Andre ; Barreto, Elizabeth Bárcena ; Melchor, Javier Ripollés ; Becerra-Bolaños, Ángel ; Rodríguez-Pérez, Aurelio ; Estévez, Javier Mata ; Matas, Juan Mulet ; Palao, Sara Pérez ; Álvarez, Mercedes García ; Albadalejo, Albert Bainac ; González, Astrid Batalla ; Caro, Ana María Gómez ; Blanco, Ignacio Hinojal ; Fernandez, Diego Toral ; Perez, Gracia Herranz ; Ejea, Margarita Logroño ; de la Rosa Ruiz, Noelia ; Abasolo, María Gastaca ; Ferreira, Lourdes ; Lobato, Félix ; Sevilla, Marta Aguado ; Erazo, Andres ; Paulis, Berta Castellano ; de la Calle Gil, Isabel ; Adamove, Peter ; Blasco, Francho Miguel Blasco ; García-Sánchez, Jose Ignacio ; Zamorano, Sara García ; Herreros, Natalia Gijón ; Callejas, Raquel ; Gómez, Mercedes Estaire ; Candela-Toha, Angel M. ; Claros-Llamas, Elisabeth ; Cobeta-Orduña, Pilar ; Crespo-Aliseda, Pascual ; Dorado-Díaz, Trinidad ; Gómez-Rojo, María ; Mané-Ruiz, M. Nuria ; González, M. Carmen Martín- ; Martínez-Pérez, Adolfo ; Tiscar, Carlos ; Menéndez, Patricia Galán ; Calvo, Verónica Estepa ; Espí, Laura Llinares ; Aldeán, Yuri Santiago Loaiza ; Ariza, Víctor Morales ; Vila, Laura Villarino ; García-Miguel, Francisco Javier ; Suliman, Elfayadh S. M. ; Ibrahim, Ahmed Mohamed ; Fadlalmola, Hammad Ali. ; Swed, Sarya ; Wu, Vin-Cent ; Orhan-Sungur, Mukadder ; Altun, Demet ; Canbolat, Nur ; Dinçer, Müşerref Beril ; Yildirim, Serap Aktas ; Iyigun, Muzeyyen ; Yapıcı, Davud ; Özdemir, Levent ; Sagün, Aslınur ; Boztug, Neval ; Gündüz, Emel ; Lafli-Tunay, Demet ; Karakaya, Deniz ; Dost, Burhan ; Komurcu, Ozgur ; Dilmen, Ozlem Korkmaz ; Akcil, Eren Fatma ; Tunali, Yusuf ; Ok, Gulay ; Tok-Alsina, Eda ; Polat, Cengiz ; Kızılcık, Nurcan ; Şen, Öznur ; Darçın, Kamil ; Uğur, Semra ; Gürkan, Yavuz ; Saracoglu, Kemal Tolga ; Yıldız-Koyuncu, Özge ; Demir, Z. Aslı ; Postacı, N. Aysun ; Özgök, Ayşegül ; Karadeniz, Ümit ; Özay, Hülya Yiğit ; Balcı, Eda ; Salman, Nevriye ; Girgin, Behiç ; Sagir, Ozlem ; Demir, Hafize Fisun ; Ugun, Fatih ; Toprak, Hüseyin İlksen ; Özcan, Mustafa Soner ; Alkaya-Solmaz, Filiz ; Yilmaz, Mehmet ; Karaca, Umran ; Şahin, Sevtap Hekimoglu ; Erkoç, Süheyla Karadağ ; Alkış, Neslihan ; Baytaş, Volkan ; Erturk, Engin ; Saylan, Sedat ; Akdogan, Ali ; Yeşil, Beyza Büyükgebiz ; Boran, Omer Faruk ; Orak, Yavuz ; Çalişir, Feyza ; Büyükçoban, Sibel ; Kuvaki, Bahar ; Cansabuncu, Seda ; Akesen, Selcan ; Gören, Suna ; Yeniocak, Tugce ; Orman, Osman ; Karka, Özlem Ersoy ; Sahin, Tulay ; Momot, Natalia ; Panchenko, Anna ; Rutledge, Kristen

Citation: Intensive Care Medicine, Vol.50(2) : 247-257, 2024-02

Journal Title: INTENSIVE CARE MEDICINE

ISSN: 0342-4642

Issue Date: 2024-02

MeSH: Acute Disease ; Acute Kidney Injury* / epidemiology ; Acute Kidney Injury* / etiology ; Humans ; Kidney ; Prospective Studies ; Renal Insufficiency, Chronic* / epidemiology ; Renal Insufficiency, Chronic* / etiology

Keywords: Acute kidney disease ; Acute kidney injury ; Chronic kidney disease ; Postoperative ; Surgery

Abstract: Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors. © The Author(s) 2024.