Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

John R Prowle; Lui G Forni; Max Bell; Michelle S Chew; Mark Edwards; Morgan E Grams; Michael P W Grocott; Kathleen D Liu; David McIlroy; Patrick T Murray; Marlies Ostermann; Alexander Zarbock; Sean M Bagshaw; Raquel Bartz; Samira Bell; Azra Bihorac; Tong J Gan; Charles E Hobson; Michael Joannidis; Jay L Koyner; Denny Z H Levett; Ravindra L Mehta; Timothy E Miller; Michael G Mythen; Mitra K Nadim; Rupert M Pearse; Thomas Rimmele; Claudio Ronco; Andrew D Shaw; John A Kellum

doi:10.1038/s41581-021-00418-2

Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Nat Rev Nephrol. 2021 Sep;17(9):605-618. doi: 10.1038/s41581-021-00418-2. Epub 2021 May 11.

Authors

John R Prowle¹, Lui G Forni^{2

3}, Max Bell⁴, Michelle S Chew⁵, Mark Edwards⁶, Morgan E Grams⁷, Michael P W Grocott⁸, Kathleen D Liu⁹, David McIlroy¹⁰, Patrick T Murray¹¹, Marlies Ostermann¹², Alexander Zarbock¹³, Sean M Bagshaw¹⁴, Raquel Bartz¹⁵, Samira Bell¹⁶, Azra Bihorac¹⁷, Tong J Gan¹⁸, Charles E Hobson¹⁹, Michael Joannidis²⁰, Jay L Koyner²¹, Denny Z H Levett⁸, Ravindra L Mehta²², Timothy E Miller²³, Michael G Mythen²⁴, Mitra K Nadim²⁵, Rupert M Pearse²⁶, Thomas Rimmele²⁷, Claudio Ronco²⁸, Andrew D Shaw^#²⁹, John A Kellum^#³⁰

Affiliations

¹ Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK. j.prowle@qmul.ac.uk.
² Intensive Care Unit, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK.
³ Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK.
⁴ Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Anesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden.
⁶ Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁹ Divisions of Nephrology and Critical Care, Departments of Medicine and Anesthesia, University of California San Francisco School of Medicine, San Francisco, CA, USA.
¹⁰ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ School of Medicine, University College Dublin, Dublin, Ireland.
¹² Department of Intensive Care, Guy's & St Thomas' NHS Foundation Hospital, London, UK.
¹³ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
¹⁴ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
¹⁵ Division of Critical Care Medicine, Department of Anesthesia, Duke University Medical Center, Durham, NC, USA.
¹⁶ Division of Population Health and Genomics, University of Dundee, Dundee, Scotland, UK.
¹⁷ Precision and Intelligent Systems in Medicine (PrismaP), Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL, USA.
¹⁸ Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
¹⁹ The PACES Center for Value in Healthcare, Framingham, MA, USA.
²⁰ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
²¹ Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.
²² Division of Nephrology, Department of Medicine, University of California, San Diego, CA, USA.
²³ Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.
²⁴ University College London Hospitals NIHR Biomedical Research Centre, London, UK.
²⁵ Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
²⁶ Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
²⁷ Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
²⁸ Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, and Department of Medicine, University of Padova, Padova, Italy.
²⁹ Department of Anesthesiology and Pain Medicine, Alberta Health Services, Edmonton, AB, Canada.
³⁰ Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

^# Contributed equally.

Abstract

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.

Publication types

Consensus Development Conference
Review

MeSH terms

Acute Kidney Injury / etiology*
Acute Kidney Injury / physiopathology
Acute Kidney Injury / prevention & control
Humans
Kidney / physiopathology
Postoperative Complications / etiology*
Postoperative Complications / physiopathology
Postoperative Complications / prevention & control
Risk Factors

Grants and funding

R01 GM110240/GM/NIGMS NIH HHS/United States