Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

• Published in: Nature reviews. Nephrology 2021-09, Vol.17 (9), p.605-618
• Main Authors: Prowle, John R., Forni, Lui G., Bell, Max, Chew, Michelle S., Edwards, Mark, Grams, Morgan E., Grocott, Michael P. W., Liu, Kathleen D., McIlroy, David, Murray, Patrick T., Ostermann, Marlies, Zarbock, Alexander, Bagshaw, Sean M., Bartz, Raquel, Bell, Samira, Bihorac, Azra, Gan, Tong J., Hobson, Charles E., Joannidis, Michael, Koyner, Jay L., Levett, Denny Z. H., Mehta, Ravindra L., Miller, Timothy E., Mythen, Michael G., Nadim, Mitra K., Pearse, Rupert M., Rimmele, Thomas, Ronco, Claudio, Shaw, Andrew D., Kellum, John A.
• Format: Article
• Language: English
• Subjects: 692/4022/272; 692/699/1585/4; 692/700/565/545; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Acute Kidney Injury - prevention & control; Acute renal failure; Anesthesiology; Care and treatment; Complications; Consensus Statement; Critical care; Epidemiology; Hospitals; Humans; Hypertension; Intensive care; Internal medicine; Kidney - physiopathology; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Pathophysiology; Physiology; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Practice guidelines (Medicine); Prevention; Risk Factors; Surgery; Surgical outcomes
• ISSN: 1759-5061; 1759-507X; 1759-507X
• DOI: 10.1038/s41581-021-00418-2

Postoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research. The development of acute kidney injury (AKI) after major non-cardiac surgery is associated with substantial long-term morbidity and mortality. This joint Consensus Statement from the Acute Disease Quality Initiative and the PeriOperative Quality Initiative provides recommendations for the definition, prevention and management of postoperative AKI.