Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Dec;49(12):1441-1455.
doi: 10.1007/s00134-023-07169-7. Epub 2023 Jul 28.

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Alexander Zarbock #  1   2 , Raphael Weiss #  3 , Felix Albert  4 , Kristen Rutledge  5 , John A Kellum  6 , Rinaldo Bellomo  7   8   9   10 , Evgeny Grigoryev  11 , Angel M Candela-Toha  12 , Z Aslı Demir  13 , Vincent Legros  14 , Peter Rosenberger  15 , Patricia Galán Menéndez  16 , Mercedes Garcia Alvarez  17 , Ke Peng  18 , Maxime Léger  19 , Wegdan Khalel  20 , Mukadder Orhan-Sungur  21 , Melanie Meersch  3 ; EPIS-AKI Investigators
Collaborators, Affiliations
Observational Study

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Alexander Zarbock et al. Intensive Care Med. 2023 Dec.

Abstract

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear.

Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay.

Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration.

Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.

Trial registration: ClinicalTrials.gov NCT04165369.

Keywords: Acute kidney injury; Epidemiology; Mortality; Perioperative; Postoperative.

PubMed Disclaimer

Conflict of interest statement

AZ received lecture fees from BioMerieux, Fresenius Medical Care and Baxter unrelated to current study and an unrestricted research grant from Baxter related to the current study. JAK is a paid consultant for BioMerieux, and a fulltime employee of Spectral Medical. Patricia Galán Menéndez reports fees from Baxter, Fresenius, MSD. MM received lecture fees from BioMerieux, Fresenius Medical Care and Baxter unrelated to current study. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart. ICU intensive care unit; PO-AKI postoperative acute kidney injury
Fig. 2
Fig. 2
Occurrence of transient/persistent PO-AKI with 95% confidence intervals according to KDIGO stage and diagnosing criteria. For example, among all patients with PO-AKI in KDIGO stage 1 diagnosed by serum creatinine alone, 71.8% turn out to be transient AKIs and 28.2% persistent AKIs
Fig. 3
Fig. 3
Occurrence of PO-AKI and hospital mortality up to day 90 with 95% confidence intervals according to A. UN-geoscheme B. percentage of health expenditure (low < 5%, medium 5–10%, high > 10%)
Fig. 4
Fig. 4
Hospital mortality up to day 90 with 95% confidence intervals according to KDIGO stage and diagnosing criteria
See this image and copyright information in PMC

References

    1. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, Gawande AA. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385(Suppl 2):S11. doi: 10.1016/S0140-6736(15)60806-6. - DOI - PubMed
    1. Prowle JR, Forni LG, Bell M, Chew MS, Edwards M, Grams ME, Grocott MPW, Liu KD, McIlroy D, Murray PT, Ostermann M, Zarbock A, Bagshaw SM, Bartz R, Bell S, Bihorac A, Gan TJ, Hobson CE, Joannidis M, Koyner JL, Levett DZH, Mehta RL, Miller TE, Mythen MG, Nadim MK, Pearse RM, Rimmele T, Ronco C, Shaw AD, Kellum JA. postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the acute disease quality initiative and perioperative quality initiative. Nat Rev Nephrol. 2021 doi: 10.1038/s41581-021-00418-2. - DOI - PMC - PubMed
    1. Murugan R, Kellum JA. Acute kidney injury: what's the prognosis? Nat Rev Nephrol. 2011;7:209–217. doi: 10.1038/nrneph.2011.13. - DOI - PMC - PubMed
    1. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–523. doi: 10.1097/ALN.0000000000000765. - DOI - PubMed
    1. Grams ME, Sang Y, Coresh J, Ballew S, Matsushita K, Molnar MZ, Szabo Z, Kalantar-Zadeh K, Kovesdy CP. Acute kidney injury after major surgery: a retrospective analysis of veterans health administration data. Am J Kidney Dis. 2016;67:872–880. doi: 10.1053/j.ajkd.2015.07.022. - DOI - PMC - PubMed

Publication types

Associated data

LinkOut - more resources