Meta-analysis of AKI to CKD transition in perioperative patients
Abstract Background Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI. Methods A MEDLINE search was performed for “AKI, CKD, chronic renal insufficiency, surgery, and perio...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | Perioperative Medicine |
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| Online Access: | https://doi.org/10.1186/s13741-021-00192-6 |
| _version_ | 1829531146439884800 |
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| author | Pedro M. Abdala Elizabeth A. Swanson Michael P. Hutchens |
| author_facet | Pedro M. Abdala Elizabeth A. Swanson Michael P. Hutchens |
| author_sort | Pedro M. Abdala |
| collection | DOAJ |
| description | Abstract Background Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI. Methods A MEDLINE search was performed for “AKI, CKD, chronic renal insufficiency, surgery, and perioperative” and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and underwent analysis. Two-by-two tables were constructed from AKI +/− and CKD +/− data. The R package metafor was employed to determine odds ratio (OR), and a random-effects model was used to calculate weighted ORs. Leave-1-out, funnel analysis, and structured analysis were used to estimate effects of study heterogeneity and bias. Results Nonperioperative studies included studies of oncology, percutaneous coronary intervention, and myocardial infarction patients. Perioperative studies comprised patients from cardiac surgery, vascular surgery, and burns. There was significant heterogeneity, but risk of bias was overall assessed as low. The OR for AKI versus non-AKI patients developing CKD in all studies was 4.31 (95% CI 3.01–6.17; p < 0.01). Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared to non-AKI patients (95% CI 2.06–5.34; p < 0.01) while perioperative patients demonstrated OR 5.20 (95% CI 3.12–8.66; p < 0.01) for the same event. Conclusions We conclude that studies conducted in perioperative and nonperioperative patient populations suggest similar risk of development of CKD after AKI. |
| first_indexed | 2024-12-16T18:16:50Z |
| format | Article |
| id | doaj.art-cfee37e7ad0f4b41b756cbc4a8ba413b |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-12-16T18:16:50Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-cfee37e7ad0f4b41b756cbc4a8ba413b2022-12-21T22:21:40ZengBMCPerioperative Medicine2047-05252021-06-011011710.1186/s13741-021-00192-6Meta-analysis of AKI to CKD transition in perioperative patientsPedro M. Abdala0Elizabeth A. Swanson1Michael P. Hutchens2Anesthesiology & Perioperative Medicine, Oregon Health & Science UniversityMedical Scientist Training Program, Oregon Health & Science UniversityAnesthesiology & Perioperative Medicine, Oregon Health & Science UniversityAbstract Background Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI. Methods A MEDLINE search was performed for “AKI, CKD, chronic renal insufficiency, surgery, and perioperative” and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and underwent analysis. Two-by-two tables were constructed from AKI +/− and CKD +/− data. The R package metafor was employed to determine odds ratio (OR), and a random-effects model was used to calculate weighted ORs. Leave-1-out, funnel analysis, and structured analysis were used to estimate effects of study heterogeneity and bias. Results Nonperioperative studies included studies of oncology, percutaneous coronary intervention, and myocardial infarction patients. Perioperative studies comprised patients from cardiac surgery, vascular surgery, and burns. There was significant heterogeneity, but risk of bias was overall assessed as low. The OR for AKI versus non-AKI patients developing CKD in all studies was 4.31 (95% CI 3.01–6.17; p < 0.01). Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared to non-AKI patients (95% CI 2.06–5.34; p < 0.01) while perioperative patients demonstrated OR 5.20 (95% CI 3.12–8.66; p < 0.01) for the same event. Conclusions We conclude that studies conducted in perioperative and nonperioperative patient populations suggest similar risk of development of CKD after AKI.https://doi.org/10.1186/s13741-021-00192-6SurgeryPerioperativeacute kidney injuryChronic kidney diseaseLong-term outcomes of surgery |
| spellingShingle | Pedro M. Abdala Elizabeth A. Swanson Michael P. Hutchens Meta-analysis of AKI to CKD transition in perioperative patients Perioperative Medicine Surgery Perioperative acute kidney injury Chronic kidney disease Long-term outcomes of surgery |
| title | Meta-analysis of AKI to CKD transition in perioperative patients |
| title_full | Meta-analysis of AKI to CKD transition in perioperative patients |
| title_fullStr | Meta-analysis of AKI to CKD transition in perioperative patients |
| title_full_unstemmed | Meta-analysis of AKI to CKD transition in perioperative patients |
| title_short | Meta-analysis of AKI to CKD transition in perioperative patients |
| title_sort | meta analysis of aki to ckd transition in perioperative patients |
| topic | Surgery Perioperative acute kidney injury Chronic kidney disease Long-term outcomes of surgery |
| url | https://doi.org/10.1186/s13741-021-00192-6 |
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