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Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: A systematic review and meta-analysis

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dc.contributor.authorMooney, J.
dc.contributor.authorRanasinghe, I.
dc.contributor.authorChow, C.
dc.contributor.authorPerkovic, V.
dc.contributor.authorBarzi, F.
dc.contributor.authorZoungas, S.
dc.contributor.authorHolzmann, M.
dc.contributor.authorWelten, G.
dc.contributor.authorBiancari, F.
dc.contributor.authorWu, V.
dc.contributor.authorTan, T.
dc.contributor.authorCass, A.
dc.contributor.authorHillis, G.
dc.date.issued2013
dc.description.abstractBACKGROUND: 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.
dc.identifier.citationAnesthesiology, 2013; 118(4):809-824
dc.identifier.doi10.1097/ALN.0b013e318287b72c
dc.identifier.issn0003-3022
dc.identifier.issn1528-1175
dc.identifier.urihttps://hdl.handle.net/1959.8/162629
dc.language.isoen
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.relation.fundingHeart Foundation Career Development Award
dc.relation.fundingNew South Wales Cardiovascular Research Network/Heart Foundation Career Development Fellowship
dc.relation.fundingNew South Wales Office for Science and Medical Research Life Sciences Research Award
dc.relation.fundingNHMRC Career Development Fellowship
dc.relation.fundingNHMRC postgraduate scholarship
dc.relation.fundingRoyal Australasian College of Physicians McGaughey Research Entry Scholarship
dc.relation.fundingWestmead Hospital Association BJ Amos Travelling Fellowship
dc.rightsCopyright 2013 The American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins Access Condition Notes: This article is freely available from the publisher
dc.source.urihttps://doi.org/10.1097/ALN.0b013e318287b72c
dc.subjectHumans
dc.subjectCardiovascular Diseases
dc.subjectPostoperative Complications
dc.subjectCreatinine
dc.subjectGlomerular Filtration Rate
dc.subjectPrognosis
dc.subjectRisk
dc.subjectRetrospective Studies
dc.subjectCohort Studies
dc.subjectFollow-Up Studies
dc.subjectProspective Studies
dc.subjectFemale
dc.subjectMale
dc.subjectPreoperative Period
dc.subjectAcute Kidney Injury
dc.titlePreoperative estimates of glomerular filtration rate as predictors of outcome after surgery: A systematic review and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9915909657601831

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