Kidney Week

Abstract: SA-OR014

The Association Between Intraoperative Fluid Balance and Postoperative AKI in Noncardiac Surgery

Session Information

• AKI: Risk Factors, Biomarkers, and Predictors
  November 09, 2019 | Location: Salon C, Walter E. Washington Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Nishimoto, Masatoshi, Nara Medical University, Kashihara, Nara, Japan

Masatoshi Nishimoto, MD

• Tagawa, Miho, Nara Medical University, Kashihara, Nara, Japan

Miho Tagawa,

• Kokubu, Maiko, Nara Prefecture General Medical Center, Nara, NARA, Japan

Maiko Kokubu,

• Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Osaka-Fu, Japan

Takayuki Hamano,

• Matsui, Masaru, Nara Prefecture General Medical Center, Nara, NARA, Japan

Masaru Matsui,

• Eriguchi, Masahiro, Nara Medical University, Kashihara, Nara, Japan

Masahiro Eriguchi,

• Samejima, Ken-ichi, Nara Medical University, Kashihara, Nara, Japan

Ken-ichi Samejima,

• Akai, Yasuhiro, Nara Medical University, Kashihara, Nara, Japan

Yasuhiro Akai,

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Nara, Japan

Kazuhiko Tsuruya,

Background

Insufficient fluid administration may cause prerenal acute kidney injury (AKI) though excess fluid administration was reported to be associated with postoperative AKI in cardiac surgery. Little is known about the association between intraoperative fluid balance (IFB) and postoperative AKI in non-cardiac surgery.

Methods

This is a retrospective cohort study on adults who underwent non-cardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University. Exclusion criteria were urological or obstetric surgery, those with missing data for analyses, and preoperative dialysis. The exposure of interest was IFB and outcome variable was postoperative AKI, defined as KDIGO criteria, within 1 week after surgery. IFB was defined as (amount of fluid administration − urine output − amount of bleeding) / body weight. Data were analyzed using logistic regression models.

Results

Data for 5,168 subjects were available for analyses. Median age was 63, 46.7% were male, and baseline eGFR was 78.2. AKI was observed in 309 (6.0%). Higher IFB (per 1 SD) was independently associated with postoperative AKI after adjustment for baseline characteristics, intraoperative blood pressure, and intraoperative use of medications (Table 1). A subgroup analysis indicated the association between higher IFB and AKI was similar across intraoperative urine output or amount of bleeding (p for interaction = 0.27 and 0.43, respectively). There were no effect modifications by age, sex, preoperative renal function, or prior history of cardiovascular disease.

Conclusion

Higher IFB was independently associated with postoperative AKI. Association was similar across urine output. These results suggest that the association was not due to decrease in intraoperative urine output. Excessive fluid administration might cause renal congestion and subsequent AKI.