02490nas a2200277   4500000000100000008004100001100001400042700001900056700001600075700001400091700001600105700001000121700002100131700001400152700001900166700001800185700001100203700001500214700001900229245013500248250001500383300001100398490000800409520174900417020004602166       2013                            d1 aMooney J.1 aBarzi Federica1 aHolzmann M.1 aWelten G.1 aBiancari F.1 aWu V.1 aRanasinghe Isuru1 aCass Alan1 aZoungas Sophia1 aHillis Graham1 aTan T.1 aChow Clara1 aPerkovic Vlado00aPreoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis  a2013/02/05  a809-240 v1183 a<p>
BACKGROUND: Kidney dysfunction is a strong determinant of prognosis in many settings. METHODS: A systematic review and meta-analysis was undertaken to explore the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes after surgery. Cohort studies reporting the relationship between eGFR and major outcomes, including all-cause mortality, major adverse cardiovascular events, and acute kidney injury after cardiac or noncardiac surgery, were included. RESULTS: Forty-six studies were included, of which 44 focused exclusively on cardiac and vascular surgery. Within 30 days of surgery, eGFR less than 60 m l . min . 1.73 m(-2) was associated with a threefold increased risk of death (multivariable adjusted relative risk [RR] 2.98; 95% confidence interval [CI] 1.95-4.96) and acute kidney injury (adjusted RR 3.13; 95% CI 2.22-4.41). An eGFR less than 60 ml . min . 1.73(-2) m was associated with an increased risk of all-cause mortality (adjusted RR 1.61; 95% CI 1.38-1.87) and major adverse cardiovascular events (adjusted RR 1.49; 95% CI 1.32-1.67) during long-term follow-up. There was a nonlinear association between eGFR and the risk of early mortality such that, compared with patients having an eGFR more than 90 ml . min . 1.73m(-2) the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml . min . 1.73 m(-2) was 1.62 (95% CI 1.43-1.80), rising to 2.85 (95% CI 2.49-3.27) in patients with an eGFR less than 30 ml . min . 1.73 m(-2) and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml . min . 1.73 m(-2). CONCLUSION: : There is a powerful relationship between eGFR, and both short- and long-term prognosis after, predominantly cardiac and vascular, surgery.
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  a1528-1175 (Electronic)0003-3022 (Linking)