Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy

Panu Uusalo,Mikko J Järvisalo,Tapio Hellman

doi:10.1186/s13741-021-00227-y

Panu Uusalo, Mikko J Järvisalo + Show 1 more

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https://doi.org/10.1186/s13741-021-00227-y

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Abstract

BackgroundPerioperative acute kidney injury (AKI) is associated with multiple postoperative complications leading to prolonged hospital stay and higher costs. AKI requiring continuous renal replacement therapy (CRRT) after surgery has an incidence of 2–6% and mortality approximates 40–60%. Previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and there are very limited data on broad surgical patient populations requiring CRRT. We examined long-term mortality and factors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period.MethodsSurgical patients admitted to the intensive care unit (ICU) of academic tertiary hospital requiring CRRT between years 2010–2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Extracted data included patient demographics, comorbidities, and clinical parameters at ICU admission and at the initiation of CRRT. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after ICU admission.ResultsA total of 157 patients were included in the study. ICU mortality was 42.7%, 90-day mortality 58.0% and 1-year mortality 62.4%. Blood lactate at ICU admission and CRRT initiation were independently associated with mortality in the multivariate models. Patients with lactate > 4 mmol/l had higher mortality than patients with normal lactate (77% vs. 21%) (p < 0.001). Creatinine (p = 0.004) and eGFR (p < 0.001) remained significantly altered at 1 year of follow-up compared to baseline.ConclusionsPatients undergoing surgery and requiring perioperative CRRT in the ICU have a high risk of mortality. Mortality appears to be independently associated with lactate levels.

Highlights

Major surgery is among the most common risk factors for acute kidney injury (AKI) (Hobson et al, 2009)
A vast majority of previous studies examining mortality in perioperative AKI patients managed with continuous renal replacement therapy (CRRT) have concentrated on cardiac surgery patients and several studies have shown that blood lactate is associated with mortality after cardiac surgery (Maillet et al, 2003; Minton & Sidebotham, 2017)
Our current results show that mortality is high in mixed surgical patients with perioperative AKI requiring CRRT

Summary

Introduction

Major surgery is among the most common risk factors for acute kidney injury (AKI) (Hobson et al, 2009). A vast majority of previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and several studies have shown that blood lactate is associated with mortality after cardiac surgery (Maillet et al, 2003; Minton & Sidebotham, 2017). There are very limited data on factors associated with mortality in broad surgical patient populations requiring CRRT. Previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and there are very limited data on broad surgical patient populations requiring CRRT. We examined long-term mortality and factors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period

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