Risk Factors for the Development of Acute Renal Lesion in the Immediate Postoperative Period

Abstract

Introduction: Acute renal dysfunction is frequent in surgical patients.Objective: To identify the risk factors that influence the development of acute kidney injury during the immediate postoperative period in four years.Methods: A case-control study was carried out, with 750 controls and 230 cases. Chi-square (α<0.05), odds ratio [OR] (95% confidence interval [95% CI]) and calculation of predictive values were used.Results: The frequency was 23.4%. The postoperative risk factors were age over 60 years (OR: 4.0; 95% CI: 2.9-5.6) (P=0.00), emergency surgery (OR: 2.7; 95% CI: 2.1-3.6) (P=0.00), and American Society of Anesthesiologists (ASA) class IV (OR: 2.0; 95% CI: 1.4-2.8) (P=0.00). In the intraoperative and postoperative periods, the risk factors were hip fracture surgery (OR: 4.9; 95% CI: 3.2-7.5), general anesthesia (OR: 3.0; 95% CI 2.2-4.2), administration of more than 2500 mL of crystalloids (OR: 186.1; 95% CI: 107.4-321.9) (P=0.00), more than 60 mg of furosemide (OR: 3.3; 95% CI: 2.4-4.6) (P=0.00), initial acute physiology and chronic health evaluation (APACHE) II score ≥ 15 points (OR: 46; 95% CI: 28.1-74.8) (P=0.00). The highest predictive value was obtained by the initial APACHE II (sensitivity of 92.0% and specificity of 80.0%).Conclusions: The control of risk factors in the immediate postoperative period would reduce the incidence of acute renal injury significantly, especially in patients aged over 60 years, who underwent emergency surgery, received general anesthesia, with hip fracture and APACHE II above 15 points. Normovolemia must be guaranteed, as well as individualizing and optimizing the relationship dose–time of exposure of furosemide, blood products and vasoactive amines. Keywords: acute renal lesion; incidence; surgical; risk factors.

Keywords

• lesión renal aguda, quirúrgicos, incidencia, factores de riesgo.