• J Clin Med · Nov 2018

    Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery.

    • Diamantina Marouli, Kostas Stylianou, Eleftherios Papadakis, Nikolaos Kroustalakis, Stavroula Kolyvaki, Georgios Papadopoulos, Christos Ioannou, Alexandra Papaioannou, Eugene Daphnis, Dimitris Georgopoulos, and Helen Askitopoulou.
    • Departments of Anaesthesiology, University Hospital of Heraklion, 71110 Crete, Greece. marouli_matina@yahoo.gr.
    • J Clin Med. 2018 Nov 9; 7 (11).

    BackgroundPostoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery.MethodsThis was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI.ResultsEleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g-1 (OR = 6.88, 95% CI: 1.43⁻33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46⁻32.4, p = 0.015).ConclusionPreoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

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