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.
AD - The George Institute for Global Health, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050 Australia. jmooney@georgeinstitute.org.au AN - 23377223 BT - Anesthesiology DP - NLM ET - 2013/02/05 J2 - LA - eng M1 - 4 N1 - Mooney, John FRanasinghe, IsuruChow, Clara KPerkovic, VladoBarzi, FedericaZoungas, SophiaHolzmann, Martin JWelten, Gijs MBiancari, FaustoWu, Vin-CentTan, Timothy CCass, AlanHillis, Graham SMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewUnited StatesAnesthesiology. 2013 Apr;118(4):809-24. doi: 10.1097/ALN.0b013e318287b72c. N2 -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.
PY - 2013 SN - 1528-1175 (Electronic)0003-3022 (Linking) SP - 809 EP - 24 ST - T2 - Anesthesiology TI - Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis VL - 118 ER -