Perioperative Acute Kidney Injury

Sam D. Gumbert, M.D.; Felix Kork, M.D., M.Sc.; Maisie L. Jackson, M.D.; Naveen Vanga, M.D.; Semhar J. Ghebremichael, M.D.; Christy Y. Wang, M.D.; Holger K. Eltzschig, M.D., Ph.D.

Disclosures

Anesthesiology. 2019;132(1):180-204. 

In This Article

Patient-associated Risk Factors for Acute Kidney Injury

Several elements are correlated with a heightened risk for perioperative acute kidney injury in patients. Preexisting perioperative elevation of creatinine (more than 1.2 mg/dl) is a significant predictor for postoperative acute kidney injury among both cardiac and noncardiac surgery populations.[30,31,40] Furthermore, independent risk factors for perioperative acute kidney injury include advanced age, African American race, preexisting hypertension, active congestive heart failure, chronic kidney disease, pulmonary disease, insulin-dependent diabetes mellitus, peripheral vascular disease, presence of ascites, and high body mass index.[25,29,30,55–62] For example, acute kidney injury prevalence among bariatric surgery cases is around 6 to 8%.[60–62] In addition to being a general risk factor, a high body mass index may increase the risk of perioperative acute kidney injury. It is hypothesized that an increase in oxidative stress, proinflammatory cytokines, and endothelial dysfunction associated with obesity could influence whether a patient develops acute kidney injury.[29,59–62] Conflicting data exist regarding the influence of sex on acute kidney injury occurrence. Within cardiac surgery literature, the evidence is inconclusive with conflicting results that female sex may pose an increased perioperative risk for developing acute kidney injury.[55] However, among general surgery patients, the American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) 2005 to 2006 national data collection showed that male sex, rather than female, doubles the acute kidney injury threat after general surgery.[58] From a clinical perspective, many of these factors are not modifiable. Identifying these patient-associated comorbidities may help with individual preoperative risk stratification and prevention. Such clinical risk factors may include male sex, particularly in general surgery patients, obesity, advanced age, African American race, preexisting hypertension, active congestive heart failure, chronic kidney disease, pulmonary disease, insulin-dependent diabetes mellitus, and peripheral vascular disease.

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