Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative.
Prowle John R, Forni Lui G, Bell Max, Chew Michelle S, Edwards Mark, Grams Morgan E, Grocott Michael P W, Liu Kathleen D, McIlroy David, Murray Patrick T, Ostermann Marlies, Zarbock Alexander, Bagshaw Sean M, Bartz Raquel, Bell Samira, Bihorac Azra, Gan Tong J, Hobson Charles E, Joannidis Michael, Koyner Jay L, Levett Denny Z H, Mehta Ravindra L, Miller Timothy E, Mythen Michael G, Nadim Mitra K, Pearse Rupert M, Rimmele Thomas, Ronco Claudio, Shaw Andrew D, Kellum John A
Nature reviews. Nephrology · 2021 · PMID 33976395 · 인용 305
Postoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA).
Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.