Open AccessImpact of postoperative acute kidney injury in patients undergoing major gastrointestinal surgery on 1-year survival and renal outcomes: a national multicentre cohort study
Author(s) -
Kenneth A McLean,
Sivesh K. Kamarajah,
Emily Mills,
James Glasbey,
Dmitri Nepogodiev,
Aditya Borakati,
Josh Burke,
Thomas M Drake,
Michael Bath,
H A Claireaux,
Buket Gundogan,
Midhun Mohan,
Praveena Deekonda,
Chia Yew Kong,
Holly Joyce,
Lisa McNamee,
Evelina Woin,
Chetan Khatri,
J.E.F. Fitzgerald,
Ewen M. Harrison,
Aneel Bhangu,
Nishkantha Arulkumaran,
Samira Bell,
Fiona Duthie,
Jeremy Hughes,
Thomas Pinkney,
John R. Prowle,
Toby Richards,
Mark Thomas,
K Dynes,
Mulchand S. Patel,
Prashant Patel,
Catrin Wigley,
Rishi Suresh,
Andrew Shaw,
Stefan Klimach,
P Jull,
David A. Evans,
Ryan Preece,
I. Ibrahim,
Venughanan Manikavasagar,
R Smith,
Steven R. Brown,
Ryan Yee Wei Teo,
D P Y Sim,
Andrew Logan,
Ishani Barai,
H Amin,
Sukrit Suresh,
R. Sethi,
W Gul,
William Bolton,
O Corbridge,
L. Horne,
Mark Attalla,
R Morley,
Caitlin Robinson,
Toby Hoskins,
Ross McAllister,
S Lee,
Y Dennis,
G Nixon,
Emily G. Heywood,
Holly Wilson,
Lauren C. Ng,
S. Samaraweera,
Alexandra Mills,
Colin P. Doherty,
Jessica Belchos,
Véronique Phan,
Markus Arnold,
Sharaf SheikAli,
Andrea Cordaro,
Niels Lörch,
D. Thomas,
B Ibrahim,
Soo Khee Chee,
Thomas Ngan,
Savva Pronin,
Nimish Thakral,
T Yeoh,
JoAnne Wilson,
R. Goodson,
P. J. Molloy,
Melika Akhbari,
Rebecca Helliwell,
Sarah Rees,
M Al-Attar,
Nathan Griffiths,
Jonathan Mayes,
Paul V. Thomas,
Stephanie M. George,
Arron AT Thind,
Mike Kerr,
Faraz Shafiq,
Ifat Yasin,
Mark M. Gallagher,
Emma Sewart,
Tarak Chouari,
Thomas W. Gardner,
N Goergen,
John Hayes,
Calum Macleod,
Roisin McCormack,
A. McKinley,
Steven McKinstry,
William Milligan,
London Lucien Ooi,
N M Rafiq,
T Sammut,
Elizabeth M. Sinclair,
M Smith,
Clayton Baker,
Alex Boulton,
Jorja Collins,
Hannah C. Copley,
Nicola Fearnhead,
Hannah Fox,
Tammy S. Mah,
James McKenna,
Vinci Naruka,
Neha Nigam,
Basil Nourallah,
S. Perera,
A Qureshi,
Shamit Saggar,
Lianqin Sun,
X Wang,
Donghui Yang,
P Caroll,
C Doyle,
Satheesh Elangovan,
A Falamarzi,
Kiara Gascon Perai,
Emily Greenan,
D Jain,
Melanie LangOrsini,
Shir Lynn Lim,
Lisa O’Byrne,
Paul F. Ridgway,
Sharon Van Der Laan,
J Wong,
Thomas Arthur,
J Barclay,
PM Bradley,
Claire Edwin,
Emily Finch,
Eri Hayashi,
Marilyn Hopkins,
Deborah Kelly,
Michael E. Kelly,
Neil McCartan,
Alice Ormrod,
A Pakenham,
Jade Hayward,
C. Hitchen,
A. Kishore,
Tiago Martins,
J Philomen,
R Rao,
C. Rickards,
Nancy Burns,
M. Copeland,
Christine M. Durand,
A Dyal,
Ali Ghaffar,
AL Gidwani,
Michael Grant,
C Gribbon,
Almir Adolfo Gruhn,
Martin Leer,
K. Ahmad,
Gillian M. Beattie,
Matthew Beatty,
G Campbell,
Gordon A. Donaldson,
Sharon S. Graham,
DaJuanicia N. Holmes,
S. Kanabar,
H Liu,
Cameron McCann,
Richard Stewart,
S. Vara,
O Ajibola-Taylor,
E J E Andah,
Chizobam Ani,
N M O Cabdi,
G Ito,
Mark R. Jones,
A Komoriyama,
L Titu,
Melvinder Basra,
P Gallogly,
G Harinath,
SH Leong,
Akshyaya Pradhan,
Imran Siddiqui,
S.A.J. Zaat,
Ahmed Ali,
Mark Galea,
Wan Limm Looi,
James Ng,
Gary Atkin,
Arash Azizi,
Zillah Cargill,
Z China,
J.M. Elliot,
R Jebakumar,
John C. Lam,
Gagira Mudalige,
C Onyerindu,
M Renju,
Veena Babu,
P Hussain,
Nikita Joji,
B Lovett,
H Mownah,
B Ali,
Ben Cresswell,
Ajit Dhillon,
Y S Dupaguntla,
Chipo Hungwe,
Jack LoweZinola,
J C H Tsang,
K Bevan,
C Cardus,
Anchal Duggal,
Mohammad Sohrab Hossain,
Michael A. McHugh,
Michael J. Scott,
F Chan,
Roger G. Evans,
E Gurung,
Brenda P. Haughey,
B Jacob-Ramsdale,
J Lee,
E McCann,
Kathy M. O’Boyle,
Neil Reid,
Faisal Hayat,
Sarah Hodgson,
Richard A. Johnston,
W. Schuyler Jones,
M. Anwar H. Khan,
Thomas Linn,
Stuart Long,
P Seetharam,
Susan Shaman,
Benjamin Smart,
A. Anilkumar,
Justine Davies,
Julie Griffith,
B Hughes,
Y. Islam,
Debora Kidanu,
N Mushaini,
Iqra Qamar,
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Harry Apperley,
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Jane Blazeby,
Sheila Can,
S Carse,
A. Göpfert,
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Richard J. Telfer,
I Whybrow Huppatz,
E Worley,
L Chandramoorthy,
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L. Harris,
Prateek Jain,
M J Karim,
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John E. McGillicuddy,
C Rafferty,
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D Zanichelli,
Matthew Arneill,
Bill Campbell,
Lauren Crozier,
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Aqua Asif,
Martin J. Connor,
Shiva Dindyal,
Nikhil Math,
Aalia Pagarkar,
Hamza Saleem,
Ishith Seth,
N Standfield,
Timen Swartbol,
Robbie Adamson,
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W Ho,
N R Javaid,
A. Mehdi,
Deepak Me,
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Oliver Warren,
Emily Crane,
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C Gadsby,
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Katie A. Dunleavy,
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Abhaya Kumar,
A Redmond,
Samuel L. Skulsky,
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Yadav Sardar,
Shakeel R. Saeed,
Emily Ang,
Bengi Kansu,
R Walford,
Cathy E. Woodward,
Sherif Babatunde Adeyemi,
Richard A. Awad,
Lema Imam,
Helen Patterson,
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Publication year - 2021
Publication title -
bjs open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.974
H-Index - 9
ISSN - 2474-9842
DOI - 10.1093/bjsopen/zrab134
Subject(s) - medicine , acute kidney injury , hazard ratio , renal replacement therapy , prospective cohort study , kidney disease , cohort , cohort study , surgery , confidence interval
Background The intermediate-term impact of acute kidney injury (AKI) in patients after major gastrointestinal and liver surgery has not been well characterized. This study aimed to evaluate the 1-year mortality rate and renal outcomes associated with postoperative AKI in a national prospective cohort. Methods This prospective multicentre, observational cohort with 1-year postoperative follow-up included adults undergoing major gastrointestinal and liver surgery across the UK and Ireland between 23 September and 18 November 2015. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was death at 1-year after surgery, and the secondary outcome was Major Adverse Kidney Events (MAKE-365). Cox proportionate and multilevel logistic regression were used to account for case mix. Results Of 5745 patients across 173 centres, 1-year follow-up data was completed for 3504 patients (62.2 per cent, 126 centres), with attrition largely explained by centre non-participation (63.1 per cent). Some 13.6 per cent (475 of 3504) patients developed AKI by 7 days after surgery (stage 1: 9.2 per cent; stage 2/3: 4.3 per cent). At 1 year, 10.8 per cent (378 patients) experienced a MAKE-365 endpoint (303 patients had died, 61 had renal replacement therapy and 78 had renal dysfunction). Patients who experienced AKI by 7 days after surgery had a higher hazard of death at 1 year for KDIGO stage 1 (hazard ratio 1.50 (95 per cent c.i. 1.08 to 2.08), P = 0.016) and KDIGO stage 2/3 (hazard ratio 2.96 (95 per cent c.i. 2.02 to 4.33), P < 0.001). Both KDIGO stage 1 (odds ratio 2.09 (95 per cent c.i. 1.50 to 2.92), P < 0.001) and stage 2/3 (odds ratio 9.26 (95 per cent c.i. 6.31 to 13.59), P < 0.001) AKI were independently associated with MAKE-365. Conclusion AKI events within 7 days after gastrointestinal or liver surgery are associated with significantly worse survival and renal outcomes at 1 year.
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