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Tytuł:
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Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.
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Autorzy:
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Harrison TG; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Ruzycki SM; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
James MT; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ronksley PE; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Zarnke KB; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Tonelli M; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Manns BJ; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
McCaughey D; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Schneider P; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Dixon E; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Hartley RL; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Owen VS; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Ma Z; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Hemmelgarn BR; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: .
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Źródło:
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American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2021 Mar; Vol. 77 (3), pp. 365-375.e1. Date of Electronic Publication: 2020 Oct 09.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Philadelphia Pa : W.B. Saunders
Original Publication: New York, N.Y. : Grune & Stratton, c1981-
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MeSH Terms:
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Glomerular Filtration Rate*
Kidney Failure, Chronic/*epidemiology
Surgical Procedures, Operative/*statistics & numerical data
Adult ; Aged ; Aged, 80 and over ; Alberta/epidemiology ; Cohort Studies ; Creatinine/metabolism ; Female ; Hospitalization ; Humans ; Incidence ; Kidney Failure, Chronic/metabolism ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Renal Dialysis ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/metabolism ; Retrospective Studies
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Contributed Indexing:
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Keywords: Kidney disease; cardiac surgery; chronic kidney disease (CKD); cohort study; dialysis; estimated glomerular filtration rate (eGFR); incidence; major surgery; musculoskeletal procedures; perioperative; renal function; serum creatinine; surgical risk; vascular surgery
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Substance Nomenclature:
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AYI8EX34EU (Creatinine)
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Entry Date(s):
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Date Created: 20201011 Date Completed: 20210322 Latest Revision: 20210322
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Update Code:
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20240105
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DOI:
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10.1053/j.ajkd.2020.08.009
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PMID:
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33039431
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Rationale & Objective: Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function.
Study Design: Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016.
Setting & Participants: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort.
Exposure: Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m 2 with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period.
Outcome: Major surgery defined as surgery requiring admission to the hospital for at least 24 hours.
Analytical Approach: Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated.
Results: 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery.
Limitations: Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included.
Conclusions: People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.
(Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
