Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

Perioperative Medicine

Laura Paparella¹  Silvia De Rosa²  Marco Allinovi³  Vittorio Bocciero⁴  Thomas Saitta⁴  Dario Degl’Innocenti⁴  Caterina Scirè Calabrisotto⁴  Alessandro Nerini⁴  Stefano Romagnoli⁵  Gianluca Villa⁵  Angelo R. De Gaudio⁵  Marlies Ostermann⁶ 

[1] Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy;Department of Anaesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy;Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy;Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy;Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy;Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy;Department of Nephrology and Critical Care, Guy’s and St Thomas’ Hospital, King’s College London, London, UK;

关键词: Chronic kidney disease;    Long-term kidney dysfunction;    Glomerular filtration rate;    Serum creatinine;   

DOI  :  10.1186/s13741-021-00184-6

来源: Springer

【 摘 要 】

BackgroundPostoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease.MethodsAdult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI.ResultsA total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys.ConclusionPO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients.Trial registrationClinicalTrials.gov, NCT04341974.

【 授权许可】

CC BY