Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: A systematic review and meta-analysis
Journal
Anesthesiology
Journal Volume
118
Journal Issue
4
Pages
809-824
Date Issued
2013
Author(s)
Mooney J.F.
Ranasinghe I.
Chow C.K.
Perkovic V.
Barzi F.
Zoungas S.
Holzmann M.J.
Welten G.M.
Biancari F.
Tan T.C.
Hillis G.S.
Hillis G.S.
Abstract
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 ml·min·1.73 m 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 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·1.73 m the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m 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 and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml·min·1.73 m. CONCLUSION
SDGs
Other Subjects
acute kidney failure; adverse outcome; cardiovascular disease; confidence interval; death; estimated glomerulus filtration rate; follow up; glomerulus filtration rate; heart surgery; human; long term care; mortality; outcome assessment; preoperative evaluation; priority journal; prognosis; review; risk factor; systematic review; vascular surgery; Acute Kidney Injury; Cardiovascular Diseases; Cohort Studies; Creatinine; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Male; Postoperative Complications; Preoperative Period; Prognosis; Prospective Studies; Retrospective Studies; Risk
Type
review