Prevention of Acute Postoperative Kidney Injury

Authors

  • V.P. Shano State Institution «Institute of Urgent and Reconstructive Surgery named after V.K. Gusak of Academy of Medical Sciences of Ukraine», Donetsk
  • I.V. Gumenyuk State Institution «Institute of Urgent and Reconstructive Surgery named after V.K. Gusak of Academy of Medical Sciences of Ukraine», Donetsk
  • Ye.Z. Gubiyeva State Institution «Institute of Urgent and Reconstructive Surgery named after V.K. Gusak of Academy of Medical Sciences of Ukraine», Donetsk
  • L.L. Gaydash State Institution «Institute of Urgent and Reconstructive Surgery named after V.K. Gusak of Academy of Medical Sciences of Ukraine», Donetsk

DOI:

https://doi.org/10.22141/2224-0586.4.51.2013.89327

Keywords:

acute kidney injury, RIFLE, renal replacement therapy, hemodialysis

Abstract

Introduction. Acute postoperative kidney injury (APKI) is a common (55–65 %) component of multiple organ disorders in patients in intensive care units and leads to 2–10-fold increase of in mortality. The ideology of modern intensive care in patients with APKI is based on the concept of reversibility and overcoming acute kidney injury on the assumption of change of tactics, including preoperative APKI risk assessment using an optimized evaluation of the severity of injury, ntraoperative prevention, as well as early renal replacement therapy.
Material and Methods. A retrospective observational cohort study of acute postoperative kidney injury in order to determine the frequency and severity of APKI in 165 patients after resection of abdominal aortic aneurysm, in 74 — hernia repair, hernia plastic surgery, in 68 patients with peritonitis, in 107 — with pancreatonecrosis. Acute postoperative kidney injury was determined on RIFLE scale, the severity of the general state — on the basis of SAPS scale.
Results. The risk for APKI before operation was determined in 26.6 % of patients with abdominal aortic aneurysm, in 16 % — with pancreatonecrosis, in 22.4 % — with peritonitis; APKI risk in patients with hernias wasn’t defined before surgery.
After surgery for abdominal aortic aneurysm, stage I was detected in 69 (41.8 %) out of 165 patients, F — in 96 (58.1 %). After the hernia repair: I — in 26 patients (35,1 %), F — in 11 (14.8 %); in peritonitis: I — in 32 (47 %), F — in 5 (7.3 %); in pancreatitis, stage I was detected in 27 patients (25.2 %) out of 107, F — in 18 (16.8 %).
In the postoperative period, APKI was detected in 274 out of 414 patients, which amounted to 66.18 %. This was confirmed by the findings of a correlational analysis for correlation between occurrence of APKI and factors of surgical aggression (0.6 < r < 0.8; p < 0.05): allotransfusion 13.3 ml/kg or more, hypervolemic hemodilution 54 ml/kg or higher, blood loss volume of 12 ml/kg/h or more, the operation duration of 5 hours or longer, the duration of aortic clamping for 3.5 hours or more, intravascular hemolysis of 0.8 g/l and more, urine creatinine 4.5 mmol/day or less, plasma creatinine 0.2 mmol/l and higher, decreased glomerular filtration rate by 35 % or less from the baseline, urine urea 200 mmol/day or below for 8 hours after surgery.
The data obtained were the rationale for the change of tactics of intraoperative intensive care, including replacement of hypervolemic infusion with restrictive one; liberal way of blood replacement — with restrictive one; allotransfusion — with autotransfusion using Cell Saver apparatus. Along with it was expedient to change the terms of the renal replacement therapy — hemodialysis. Out of 154 patients in the I stage, 120 developed degree F. These patients were in need of hemodialysis treatment. Of these, 30 patients underwent hemodialysis 12 hours after surgery, each patient underwent 4 hemodialysis every other day. None of these patients died.
At the same time, the hemodialysis treatment was performed in 32 patients after 3–5 days due to the severity of the condition after the operation on the basis of common standards. Of these, 8 patients died, i.e. mortality rate was 25 %. The remaining 58 of the 120 patients who required renal replacement therapy, hemodialysis was not performed due to the critical condition and severe multiple organ disorders. The mortality of these patients was 48.3 %.
Conclusions. The risk of acute postoperative kidney injury should be determined in the preoperative period, using an optimized evaluation of the severity of RIFLE.
Diagnosis of acute postoperative kidney injury should include the impact on renal function of such factors of surgical aggression, as duration of intervention, hypervolemic hemodilution, allohemotransfusion, baseline level of creatinine and urea clearance.
In order to prevent APKI the infusion mode should be changed: hypervolemic hemodilution replace with restrictive one; blood replacement with allotransfusion — with autotransfusion using Cell Saver apparatus.

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Published

2013-09-01

How to Cite

Shano, V., Gumenyuk, I., Gubiyeva, Y., & Gaydash, L. (2013). Prevention of Acute Postoperative Kidney Injury. EMERGENCY MEDICINE, (4.51), 68–73. https://doi.org/10.22141/2224-0586.4.51.2013.89327

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Original Researches

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