Kidney Week

Abstract: PO0194

External Validation of Simple Postoperative AKI Risk (SPARK) Classification in Noncardiac Surgery: The NARA-AKI Cohort Study

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Nishimoto, Masatoshi, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan

Masatoshi Nishimoto, MD

• Murashima, Miho, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Miho Murashima,

• Kokubu, Maiko, Nara-ken Sogo Iryo Center, Nara, Nara, Japan

Maiko Kokubu,

• Matsui, Masaru, Nara-ken Sogo Iryo Center, Nara, Nara, Japan

Masaru Matsui,

• Eriguchi, Masahiro, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan

Masahiro Eriguchi,

• Samejima, Ken-ichi, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan

Ken-ichi Samejima,

• Akai, Yasuhiro, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan

Yasuhiro Akai,

• Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan

Kazuhiko Tsuruya,

Background

The aim of the present study was to externally validate Simple Post-operative AKI Risk (SPARK) index which was developed to predict post-operative acute kidney injury (PO-AKI) in non-cardiac surgery.

Methods

In a retrospective cohort study, adults with non-cardiac surgery under general anesthesia were included. Those with obstetric or urological surgery, estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m², pre-operative dialysis, expected surgical duration <1 hour, and missing data for analyses were excluded. The exposures of interest were risk factors for AKI included in SPARK index, and outcomes were PO-AKI and critical AKI. The discrimination and calibration of SPARK index were examined with receiver operating characteristic curves and calibration plots, respectively.

Results

Among 5135 subjects, 303 and 137 developed PO-AKI and critical AKI, respectively. Subjects in our cohort were older, and baseline eGFR was lower compared to SPARK cohort. In addition, the proportion of subjects with comorbidities was higher. The incidence of PO-AKI and critical AKI increased as the scores of SPARK index increase. However, areas under the curves for PO-AKI and critical AKI were both suboptimal, and the calibration was poor (Figure). Higher age, diabetes mellitus, expected surgical duration, emergency surgery, renin-angiotensin-aldosterone system blockade use, and hyponatremia included in SPARK index were not associated with PO-AKI in our cohort, resulting in overestimation of predicted probability of AKI in our cohort.

Conclusion

SPARK index is useful in identifying subjects at high risk for developing AKI pre-operatively. However, predicted probability might not be accurate in cohorts including older subjects with more comorbidities.