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The Risk of Acute Kidney Injury From Fluid Restriction and Hydroxyethyl Starch in Thoracic Surgery
- Source :
- Survey of Anesthesiology. 60:182
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Fluid is restricted in thoracic surgery to reduce acute lung injury, and hydroxyethyl starches (HES) are often administered to reduce fluid amount. This strategy may contribute to the development of acute kidney injury (AKI). We evaluated the incidence, risk factors, and prognosis of AKI in thoracic surgery. We especially focused on whether fluid restriction/HES administration increased AKI.This is a retrospective study of patients undergoing thoracic surgery in a tertiary care academic center. Postoperative AKI was diagnosed within 72 hours after surgery based on the Acute Kidney Injury Network criteria. Demographic, intraoperative, and postoperative data were compared between non-AKI and AKI groups. Logistic regression was used to model the association between risk factors and AKI.Final analysis included 1442 patients. Of these, 74 patients developed AKI (5.1%). Crystalloid restriction (≤3 mL·kg·h) was unrelated to AKI, regardless of preoperative renal functions (odds ratio [OR], 0.5; 95% confidence interval [CI] 0.2-1.4). AKI occurred more often when HES were administered to the patients with decreased renal function (OR, 7.6; 95% CI, 1.5-58.1) or having2 risk factors with normal renal function (OR, 7.2; 95% CI, 3.6-14.1). Multivariate analysis revealed several risk factors: angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, open thoracotomy, pneumonectomy/esophagectomy, diabetes mellitus, cerebrovascular disease, low albumin level, and decreased renal function.Fluid restriction neither increased nor was a risk factor for AKI. HES should be administered with caution in high-risk patients undergoing thoracic surgery.
- Subjects :
- Male
medicine.medical_specialty
Thoracic Surgical Procedure
Time Factors
Drinking
Plasma Substitutes
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Lung injury
Hydroxyethyl starch
urologic and male genital diseases
Risk Assessment
Hydroxyethyl Starch Derivatives
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
Risk Factors
medicine
Odds Ratio
Humans
Aged
Retrospective Studies
Chi-Square Distribution
urogenital system
business.industry
Patient Selection
Acute kidney injury
Retrospective cohort study
Odds ratio
Acute Kidney Injury
Middle Aged
Thoracic Surgical Procedures
medicine.disease
female genital diseases and pregnancy complications
Anesthesiology and Pain Medicine
Logistic Models
Treatment Outcome
Cardiothoracic surgery
Anesthesia
Multivariate Analysis
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 00396206
- Volume :
- 60
- Database :
- OpenAIRE
- Journal :
- Survey of Anesthesiology
- Accession number :
- edsair.doi.dedup.....29f10da4580652fa52433674a247707e