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One percent rate of
Kidney Failure after major surgery
Newswise — Patients
undergoing major, non-cardiac surgery have a
one percent risk of developing kidney
failure, and those who do have kidney damage
are at increased risk of death within a
month after their operation.
An article in the December
issue of the journal Anesthesiology helps to
clarify the rate of acute renal failure
after major surgery in patients with
previously normal kidney function. "More
importantly, we have been able to identify
which patients are at highest risk for this
complication," comments Dr. Sachin Kheterpal
of the University of Michigan Medical
School, Ann Arbor.
Dr. Kheterpal and
colleagues examined changes in kidney
function in more than 15,000 patients
undergoing major surgery, other than heart
surgery, between 2003 and 2006. Before their
operation, patients underwent tests
confirming that their kidney function was
normal or demonstrated no history of kidney
problems. The study defined acute renal
failure as about a 40 percent drop in kidney
function.
Overall, acute renal
failure developed in 121 patients—a rate of
0.8 percent. In fourteen patients (0.1
percent), kidney failure was serious enough
to require dialysis.
After adjustment for all
risks together, there were seven independent
risk factors for acute renal failure:
•Obesity (body mass index over 30)
•Older age (over 59)
•Chronic lung disease due to smoking (also
called chronic obstructive pulmonary
disease)
•Peripheral vascular disease (also often
related to smoking)
•Liver disease (often related to excessive
alcohol use)
•Emergency surgery and certain "high-risk"
surgical procedures
•Use of certain drugs during surgery,
including diuretics
The more risk factors that
were present, the higher the risk of kidney
failure. For patients with three or more
risk factors, the risk of acute renal
failure was over four percent.
Patients with acute renal failure were at
increased risk of death. Fifteen percent of
patients who developed kidney failure died
within 30 days after surgery, compared to
less than three percent for those without
kidney failure who had similar preoperative
diseases.
Acute renal failure is a known risk for
patients undergoing heart surgery, but few
studies have examined the rate of kidney
damage after other types of surgery. Even
less is known about the risk for patients
who have normal kidney function before
surgery, who have been assumed to be at low
risk.
"Our research is the first large study to
demonstrate that approximately one percent
of patients with normal preoperative renal
function experience acute renal failure
after non-cardiac operations," Dr. Kheterpal
concludes. "We have also been able to
demonstrate that the development of acute
renal failure after general surgery is
associated with a marked increase in
mortality, independent of the patient's
underlying diseases."
Future studies will help to clarify the
causes of acute renal failure in specific
groups of patients, according to an
accompanying editorial by Dr. Pamela C.
Nagle of Wake Forest University. Dr. Nagle
concludes, "Kheterpal and colleagues should
be congratulated for carefully using their
institution's large databases and reporting
potential risk factors that will hopefully
lead to further investigations and, someday
in the future, improvements that may
decrease this major perioperative
complication."
For additional information on this study, go
to:
http://www.anesthesiology.org
Founded in 1905, the American Society of
Anesthesiologists is an educational,
research and scientific association with
41,000 members organized to raise and
maintain the standards of the medical
practice of anesthesiology and improve the
care of the patient.
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