Abstract: TH-PO058
Time of Surgery Is Associated with Greater Increase in Urinary KIM-1 in Patients with Major Elective Abdominal Nonvascular Surgery-Associated AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Author
- de Souza, Graziela R. B., São Paulo University, São Paulo, São Paulo, Brazil
Background
Acute kidney injury (AKI) is a complex syndrome that occurs in a wide variety of surgical situations, and has been associated with the surgery time (ST). The aim of this study is to assess if the ST in patients (pts) developing AKI after major elective abdominal non-vascular surgeries (MEANVS) is associated with the intensity of urinary biomarkers (uBM) changes after surgery.
Methods
We studied a prospective cohort of MEANVS pts, which did the post-operatory (post-op) period in intensive care units (ICU) in a university hospital. AKI diagnosis was made by serum creatinine (SCr) or urinary output (UO) KDIGO criteria. SCr was analyzed in pre-operatory time, ICU admission and daily up to 7 days or ICU discharge. UO was evaluated hourly (mL/kg/h) trough 24 h every day. The uBMs (NGAL, KIM-1 and Nephrochek - NC) were analyzed in the immediate post-op (time 0, ICU admission) and 12 h after ICU admission. Diagnosis of chronic kidney disease stages IV/ V, nephrotoxic drugs use before surgery and ICU stay < 48 h were exclusion criteria.Statistical significance was p < 0.05.
Results
The sample was composed by 297 pts ≥ 18 y old. The most frequent surgeries were hepatectomy and gastrectomy. Among the 297 pts, 197 (66.3%) developed AKI, mostly KDIGO stage 1 (60% of 197). Using SCr criteria 71 pts were diagnosed, while the UO criteria diagnosed 126 pts (62 pts has simultaneous SCr and UO changes). Eight pts (2.6%) needed hemodialysis. Mortality in AKI pts was 9.1% and without AKI 1.9%, p = 0.0149. Among pts developing AKI 53.3% had ST ≥ 300 min. The values of all uBMs were similar at time 0, independently of the ST. At 12 h KIM-1 values were significantly higher em pts with ST ≥ 300 min as compared to < 300 min: 2.42 vs 1.62 ng/mL, p = 0.011. The values of NGAL and NC were higher at 12h in the ST ≥ 300 group, but did not reached statistical significance: 214 vs 147 ng/mL for NGAL, p = 0.387 and 18.9 vs 14.6 ng/mL, p = 0.223, for NC.
Conclusion
In conclusion, longer ST was associated with increased KIM-1 in MEANVS-associated AKI pts, suggesting an occurrence of more severe tubular injury.