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Pre-operative proteinuria and post-operative acute kidney injury in noncardiac surgery: the NARA-Acute Kidney Injury cohort study
- Source :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 35(12)
- Publication Year :
- 2019
-
Abstract
- Background Little is known about the association between pre-operative proteinuria and post-operative acute kidney injury (AKI) in noncardiac surgery. Methods This is a retrospective cohort study. Adults who underwent noncardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University Hospital were included. Those with obstetric or urological surgery, missing data for analyses or pre-operative dialysis were excluded. Exposure of interest was pre-operative proteinuria, defined as (+) or more by dipstick test. The outcome variable was post-operative AKI, defined by Kidney Disease: Improving Global Outcomes criteria, within 1 week after surgery. Multivariable logistic regression analyses were performed. Results Among 5168 subjects, 309 (6.0%) developed AKI. Pre-operative proteinuria was independently associated with post-operative AKI, with an odds ratio (OR) [95% confidence interval (CI)] of 1.80 (1.30–2.51). A sensitivity analysis restricted to elective surgery yielded a similar result. As proteinuria increased, the association with AKI became stronger [OR (95% CI) 1.14 (0.75–1.73), 1.24 (0.79–1.95), 2.75 (1.74–4.35) and 3.95 (1.62–9.62) for urinary protein (+/−), (+), (2+) and (3+), respectively]. Subgroup analyses showed proteinuria was especially associated with post-operative AKI among subjects with renin–angiotensin system inhibitors, other anti-hypertensives, hypoalbuminemia or impaired renal function (P for interaction = 0.05, 0.003, 0.09 or 0.02, respectively). Conclusions In noncardiac surgery, pre-operative proteinuria was independently associated with post-operative AKI. Subjects with proteinuria should be managed with caution to avoid AKI peri-operatively.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
030232 urology & nephrology
030204 cardiovascular system & hematology
Urinalysis
urologic and male genital diseases
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
Preoperative Care
medicine
Humans
Hypoalbuminemia
Elective surgery
Dialysis
Aged
Retrospective Studies
Transplantation
Proteinuria
business.industry
Acute kidney injury
Retrospective cohort study
Odds ratio
Acute Kidney Injury
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
Nephrology
Surgical Procedures, Operative
Female
medicine.symptom
business
Kidney disease
Subjects
Details
- ISSN :
- 14602385
- Volume :
- 35
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Accession number :
- edsair.doi.dedup.....e10b363a0b5af0663a0486ad97fd6a79