Online Supplementary Material
Incidence and associations of acute kidney injury after major
abdominal surgery: a systematic review
ME O’Connor1,2 CJ Kirwan1,2,3 RM Pearse1,2 JR Prowle1,2,3
1) Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London,
UK.
2) William Harvey Institute, Barts and the London School of Medicine and Dentistry,
Queen Mary University of London, London, UK.
3) Department of Renal and Transplant Medicine, The Royal London Hospital, Barts
Health NHS Trust, London, UK.
S1
Online Supplementary Material
Table S1: Consensus AKI definitions used in this study, only serum creatinine (SCr) criteria
are shown (urine output criteria are common to all three definitions).
RIFLE [1]
AKIN [2]
KDIGO [3]
Criteria
Creatinine
definition
Criteria
Creatinine definition
Criteria
Creatinine definition
Risk
≥ 1.5-fold increase
from reference SCr
or
decrease in GFR ≥
25%
Stage 1
≥ 26 μmol/L increase within
48hrs
or
≥1.5 fold increase from
reference SCr
Stage 1
≥ 26 μmol/L increase within
48hrs
or
1.5–1.9 times baseline within
7 days
Injury
≥ 2 fold increase
from reference SCr
or
decrease in GFR ≥
50%
≥3 fold increase
from reference SCr
or
increase to ≥354
μmol/L
or
decrease in GFR ≥
75%
Stage 2
≥ 2 fold increase from
reference SCr
Stage 2
2.0–2.9 times baseline within
7 days
Stage 3
≥3 fold increase from
reference SCr
or
increase to ≥354 μmol/L
with an acute increase of
>44µmol/L
or
commenced on RRT
Stage 3
≥3 times baseline within 7
days
or
increase to ≥354 μmol/L with
an acute increase of
>26.4µmol/L
or
Initiation of renal replacement
therapy
Failure
Table S2: Study design using PICO structure
Primary Analysis
Population:
Studies reporting surgical outcomes
Intervention:
Major abdominal surgery (excluding surgeries with procedure-specific
AKI risk factors)
Comparator:
None
Outcome
AKI defined by RIFLE, AKIN or KDIGO AKI definitions
Secondary Analysis for Mortality
Population:
Major abdominal surgery studies(excluding surgeries with procedurespecific AKI risk factors) reporting post-operative AKI by consensus
definition and a mortality outcome by AKI exposure
Intervention:
Development of post-operative AKI
Comparator:
Patients without post-operative AKI
Outcome
Mortality (Hospital, 30, 60 or 90 day)
S2
Online Supplementary Material
Table S3: Detailed characteristics of the 19 included studies, ordered by date of publication (for citations see main manuscript)
Study
Author
Study Type
No.
Enrolled
Type of
Surgery
Inclusion
Criteria
Exclusion Criteria
Male
(%)
Age in years
Mean (STD) or
median (IQR)
Renal
Outcome
Mortality
Measure
(For whole
group)
Definition of
Major Surgery
Armstrong
Retrospective
cohort
1535
Elective Liver
Resection
All elective liver
resections
Long term renal
replacement therapy
58
AKIN
90 days
post-op
Nature of
procedure
Bell
Interrupted
time series
analysis of
policy change
in prophylactic
antibiotics
Retrospective
cohort
3271
General
Surgery
Having surgery
within the
specified
follow-up
period
Nil
KDIGO
Not Reported
Need for
prophylactic
antibiotics
2337
Major GI
Surgery
Major surgery,
24 hour
admission to
ICU, survived to
hospital
discharge
Patients with any
degree of CKD,
Orthopaedic, ENT,
Urology, renal
Transplant Surgery
Before
Change
43
After
change
44
55
Creat
≤124μmol/L 62
(21-86)
Creat ≥125
μmol/L 67 (2181)
After change
62.1(15.9) After
change 61.8
(16.3)
No AKI 55(16)
AKI 62(14)
RIFLE
5 years
post-op
(only considered
hospital
survivors)
Described by
authors as major
surgery
Biteker
Prospective
cohort
510
Gastrointesti
nal Surgery
Non-cardiac,
non-vascular
surgery
53
65.7(13.9)
RIFLE
90 days post-op
Described by
authors as major
gastrointestinal
surgery
(laparotomy,
advanced bowel
surgery, and
gastric surgery)
Brunelli
Retrospective
cohort
1912
Open
abdominal
surgery
Major surgical
procedure
results
Emergency surgery,
moribund patient
(ASA5 or not
expected to live >24
hours), pre-existing
renal dysfunction, on
dialysis, day case
procedure or surgery
preformed under
local anaesthetic
Previous ESRF,
dialysis, renal
transplant, AKIN
Statin
65.5
No
Statin 68.3(12.1)
No Statin
68(11.2)
AKIN
Not Reported
Described by
authors as major
open abdominal
Bihorac
S3
Online Supplementary Material
analysed by
perioperative
statin use
Causey
Retrospective
cohort
339
Colectomies
Elective and
emergency
colectomies
Chao
Retrospective
cohort
1972
Abdominal
Surgery
Older than 65
having major
surgery,
admitted to ICU
postoperatively
Cho
Prospective
cohort
111
Hepatobiliary
Elective Liver
surgery
Coca
Retrospective
cohort
11460
General
Surgery
US Veterans
Administration
Diabetic
patients having
non-cardiac
surgery, with a
pre and postoperative
creatinine
results
Liver Resection
Surgery
CorreaGallego
Retrospective
cohort
2116
Liver
Resection
stage 1 prior to
surgery, Surgery
occurring more than
3 days after
admission, no
baseline creatinine
measurement
Rectal operations
Statin
64.1
60
61.96(16.2)
RIFLE
In hospital
By nature of
surgery
Chronic dialysis,
renal replacement
therapy prior to ICU
admission postoperatively, <2day
stay in hospital, lack
of serum creatinine
results
<18 years old,
eGFR<60ml/min/1.73m2
, maintenance RRT,
preoperative AKI,
Emergency Surgery
Pre-operative AKI,
End stage renal
failure, metastatic
cancer, died during
admission
60.6
75.3(6.5)
AKIN
In hospital
Described by
authors as major
surgery
35 AKI
47 NonAKI
59.06 (10.39)
AKI
55.43 (13.47)
Non-AKI
AKIN
Not Reported –
With liver
transplant
patients
excluded
Follow up was a
minimum of
5years postoperatively
By nature of
surgery
Nil
51
90 days post-op
By nature of
surgery
94
surgery
No AKI 66(10)
AKIN
AKIN 1-67(10)
AKIN 2-66(10)
Described by
authors as major
surgery
AKIN 3-66(11)
61(51-70)
RIFLE
S4
Online Supplementary Material
Grams
Retrospective
cohort
44957
General
(Abdominal/
Gastrointestinal)
US Veterans
Administration
First instance
of major
surgery in
study period
1/10/0430/09/06
Pre-op eGFR<60
Surgery >30d after
admission
94
63 (12)
KIDGO
Not reported by
subgroup
Described by
authors as major
surgery
Kambaka
mba
Retrospective
Cohort
829
Liver
Resection
Surgery
Isolated Liver
Resection
Surgery
54
Epidural
53 (45-63)
No Epidural
60 (50-67)
AKIN
90 days post-op
By nature of
surgery
Kim
Retrospective
cohort
4718
Gastric
Cancer
Surgery
Gastrectomy or
partial
gastrectomy for
gastric cancer
67.2
63(12.1)
KDIGO
3 months postop
By nature of
surgery
Lee
Retrospective
cohort
595
Oesophageal
Surgery
Oesophageal
Surgery
94
62(8.2)
AKIN
30 days post-op
By nature of
surgery
Slankamen
ac
Retrospective
cohort
569
Liver
Resection
Liver resection
Combined
procedures,
Cirrhosis, Pre-op
sepsis, total vascular
exclusion, ESRD
Insufficient data,
emergency surgery,
CKD
[GFR<60mL/(min.1.7
3m2)], ESRF,
receiving dialysis,
renal transplant
recipient, died within
24 hours of surgery
Missing pre-op serum
creatinine, preexisting renal failure
requiring pre-op
dialysis, repeat
oesophageal surgery,
concomitant renal or
hepatic surgery
Liver resection for
trauma
55
57.2 (14.3)
RIFLE
30 days post-op
By nature of
surgery
S5
Online Supplementary Material
Sun General
Abdominal
Retrospective
cohort
1345
General
Abdominal
/GI Surgery
General
surgical
procedures
requiring
invasive
arterial blood
pressure
monitoring
Gynaecological
surgical
procedures
requiring
invasive
arterial blood
pressure
monitoring
Major
abdominal
surgery
admitted to
PACU post-op
Sun Major
Gyane
Retrospective
cohort
865
Major
Gynaecologic
al
Teixeira
Retrospective
cohort
450
Major
Abdominal
Surgery
Tomozawa
Retrospective
cohort
642
Liver
Resection
Liver Resection
Surgery
Vaught
Retrospective
cohort
2341
Major
Gynaecologic
al Surgery
Major
gynaecological
surgery and
greater than 24
hours stay in
hospital
Baseline MAP less
than 65 mmHg,
preoperative dialysis dependence, and
urologic surgery
Not
stated
by subgroup
Not stated by
sub-group
AKIN
Not reported by
subgroup
Need for arterial
line
Baseline MAP less
than 65 mmHg,
preoperative dialysis dependence, and
urologic surgery
Not
stated
by subgroup
Not stated by
sub-group
AKIN
Not reported by
subgroup
Need for arterial
line
CKD on dialysis, RRT
in week prior to
surgery, <48 hour
stay in hospital, <2
serum creatine
measurements postop, repeat surgery
Emergency surgery,
pre-op renal
replacement therapy,
died<3days post-op,
lack of data,
anaesthetic agent
other than
Sevoflurane
CKD, obstetric
procedures
50
62(16)
KDIGO
In Hospital
Described by
authors as major
surgery
72
67 (60-74)
AKIN
In Hospital
By nature or
surgery
RIFLE
90 days post-op
Described by
authors as major
surgery
0
No AKI 53(15)
AKI 60(15)
S6
Online Supplementary Material
Table S4. Studies excluded after reviewing full manuscript with reason(s) for exclusion
Author
Year
Title of Study
Abelha[4]
2009
Outcome and quality of life of patients with acute kidney injury after
major surgery
Abelha[5]
2009
Determinants of postoperative acute kidney injury
Argalious [6]
2013
Bentrem[7]
2009
Bihorac[8]
2013
Chung[9]
2015
Eachempati[10]
2007
Endo[11]
2012
Garg[12]
2014
Giustiniano[13]
2014
Glance [14]
2010
Gocze[15]
2015
Reason for exclusion
No data on AKI in patients who had
undergone major abdominal surgery
No data on AKI in patients who had
undergone major abdominal surgery
The Association of Preoperative Statin Use and Acute Kidney Injury
No data on AKI in patients who had
After Noncardiac Surgery
undergone major abdominal surgery
Identification of Specific Quality Improvement Opportunities for the Did not use a consensus definition of
Elderly Undergoing Gastrointestinal Surgery
AKI
National Surgical Quality Improvement Program Underestimates The No data on AKI in patients who had
Risk Associated with Mild and Moderate Postoperative Acute Kidney undergone only major non-vascular
Injury
abdominal surgery
Acute kidney injury after open ventral hernia repair: an analysis of
Did not use a consensus definition of
the 2005-2012 ACS-NSQIP datasets
AKI
Acute Renal Failure in Critically Ill Surgical Patients: Persistent
Did not use a consensus definition of
Lethality Despite New Modes of Renal Replacement Therapy
AKI
Intraoperative Hydroxyethyl Starch 70/0.5 Is Not Related to Acute
No data on AKI in patients who had
Kidney Injury in Surgical Patients: Retrospective Cohort Study
undergone major abdominal surgery
Perioperative Aspirin and Clonidine and Risk of Acute Kidney
No data on AKI in patients who had
InjuryA Randomized Clinical Trial
undergone major abdominal surgery
May Renal Resistive Index Be an Early Predictive Tool of
Did not use a consensus definition of
Postoperative Complications in Major Surgery? Preliminary Results
AKI and no data on AKI in patients
who had undergone major abdominal
surgery
Perioperative Outcomes among Patients with the Modified Metabolic Did not use a consensus definition of
Syndrome Who Are Undergoing Noncardiac Surgery
AKI
Urinary biomarkers TIMP-2 and IGFBP7 early predict acute kidney
Only 12 patients in includable
injury after major surgery
subgroup with hepatic surgery
S7
Online Supplementary Material
Harris[16]
2015
Epidemiology and outcomes of acute kidney injury in critically ill
surgical patients
No data on AKI in patients who had
undergone major abdominal surgery
and not all patients had been operated
on at time of inclusion
Hobson[17]
2014
Kelz[18]
2013
Kim[19]
2015
No data on AKI in patients who had
undergone major abdominal surgery
Did not use a consensus definition of
AKI
Did not use a consensus definition of
AKI
Kolhe[20]
2008
Cost and Mortality Associated With Postoperative Acute Kidney
Injury
Acute Kidney Injury, Renal Function, and the Elderly Obese Surgical
Patient A Matched Case-Control Study
Interaction Effects of Acute Kidney Injury, Acute Respiratory Failure,
and Sepsis on 30-Day Postoperative Mortality in Patients Undergoing
-High-Risk Intraabdominal General Surgical Procedures.
Case mix, outcome and activity for patients with severe acute kidney
injury during the first 24 hours after admission to an adult, general
critical care unit: application of predictive models from a secondary
analysis of the ICNARC Case Mix Programme Database
The Pattern of Longitudinal Change in Serum Creatinine and 90-Day
Mortality After Major Surgery.
Advanced age is an independent predictor for increased morbidity
and mortality after emergent surgery for diverticulitis
Perioperative Complications After Noncardiac Surgery in Patients
With Insertion of Second-Generation Drug-Eluting Stents
Postoperative complications and mortality in older patients having
non-cardiac surgery at three Melbourne teaching hospitals
Perioperative Outcomes of Major Hepatic Resections under Low
Central Venous Pressure Anesthesia: Blood Loss, Blood Transfusion,
and the Risk of Postoperative Renal Dysfunction
Statin Use Associates with a Lower Incidence of Acute Kidney Injury
after Major Elective Surgery
Combined general and neuraxial anesthesia versus general
anesthesia: a population-based cohort study
Epidemiology and outcome following post-surgical admission to
No data on AKI in patients who had
Korenkevych[21] 2015
Lidsky[22]
2012
Lo[23]
2014
McNicol[24]
2007
Melendez[25]
1998
Molnar[26]
2011
Nash[27]
2015
Rhodes[28]
2011
No data on AKI in patients who had
undergone major abdominal surgery
Major abdominal surgery subgroup
not defined
Did not use a consensus definition of
AKI
No data on AKI in patients who had
undergone major abdominal surgery
No data on AKI in patients who had
undergone major abdominal surgery
Did not use a consensus definition of
AKI
No data on AKI in patients who had
undergone major abdominal surgery
Did not use a consensus definition of
AKI
S8
Online Supplementary Material
Sabaté[29]
2011
Saze[30]
2015
Slankamenac[31] 2013
critical care
Factores de riesgo de insuficiencia renal aguda postoperatoria.
Aná lisis en una cohorte de 2.378 pacientes de 59 hospitales
Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical
Patients Based on a Japanese Nationwide Database
Novel Prediction Score Including Pre- and Intraoperative Parameters
Best Predicts Acute Kidney Injury after Liver Surgery
undergone major abdominal surgery
No data on AKI in patients who had
undergone major abdominal surgery
No documentation of AKI definition
Data on these patients already
included in another study in the
analysis
Did not use a consensus definition of
AKI
Spolverato[32]
2014
Failure to rescue as a source of variation in hospital mortality after
hepatic surgery
Story[33]
2010
Did not use a consensus definition of
AKI
Tadlock[34]
2013
Tagawa[35]
2015
Vaara[36]
2014
Wakeam[37]
2015
Complications and mortality in older surgical patients in Australia
and New Zealand (the REASON study):
a multicentre, prospective, observational study
Emergency surgery for acute diverticulitis: Which operation? A
National Surgical Quality Improvement Program study
Pre- and/or Intra-Operative Prescription of Diuretics, but Not
Renin-Angiotensin-System Inhibitors, Is Significantly Associated
with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective
Cohort Study.
The Attributable Mortality of Acute Kidney Injury: A Sequentially
Matched Analysis
Risk and Patterns of Secondary Complications in Surgical Inpatients
Walsh [38]
2013
No data on AKI in patients who had
undergone major abdominal surgery
Walsh[39]
2013
Relationship between Intraoperative Mean Arterial Pressure and
Clinical Outcomes after Noncardiac Surgery Toward an Empirical
Definition of Hypotension
The Association Between Perioperative Hemoglobin and Acute
Kidney Injury in Patients Having Noncardiac Surgery
Did not use a consensus definition of
AKI
No data on AKI in patients who had
undergone major abdominal sur
No data on AKI in patients who had
undergone major abdominal surgery
Did not use a consensus definition of
AKI
No data on AKI in patients who had
undergone major abdominal surgery
and used adjusted odds ratio for rate
of AKI
S9
Online Supplementary Material
Table S5. Newcastle-Ottowa Quality Assessment Scale for Cohort Studies (For citations see main manuscript)
Study Author
Selection
Comparability
Outcome
Overall score
Armstrong
4
0
3
7
Arbitrary
Rating
Good
Bell
4
0
3
7
Good
Bihorac
4
0
3
7
Good
Biteker
4
0
3
7
Good
Brunelli
4
2
3
9
Good
Causey
4
0
3
7
Good
Chao
4
0
3
7
Good
Cho
4
0
3
7
Good
Coca
4
0
3
7
Good
Correa-Gallego
4
0
3
7
Good
Grams
4
0
3
7
Good
Kambakamba
4
0
3
7
Good
Kim
4
0
3
7
Good
Lee
4
0
3
7
Good
Slankamenac
4
0
3
7
Good
Sun
4
0
3
7
Good
Teixeira
4
0
3
7
Good
Tomozawa
4
0
3
7
Good
Vaught AJ
4
0
3
7
Good
S10
Online Supplementary Material
Table S6. Reported stage of post-operative AKI by study (For citations see main manuscript)
Definition of AKI
Armstrong
AKIN
Number of patients
with AKI
78
Bihorac
RIFLE
918
370
(40%)
300
(33%)
248
(27%)
Coca
AKIN
2166
1737
(80%)
289
(13%)
140
(6%)
Correa-Gallego
RIFLE
336
278
(83%)
49
(15%)
9
(3%)
Grams
KDIGO
5887
4226
(71%)
989
(17%)
674
(11%)
Kim
KDIGO
679
589
(87%)
61
(9%)
29
(4%)
Lee
AKIN
210
180
(86%)
16
(8%)
14
(7%)
KDIGO
101
64
(63%)
20
(20%)
17
(17%)
Tomozawa
AKIN
78
63
(81%)
13
(17%)
2
(3%)
Vaught
RIFLE
295
185
(63%)
65
(22%)
45
(15%)
Teixeira
Stage 1 or
RIFLE –R
61
(78%)
Stage 2 or
RIFLE – I
12
(15%)
Stage 3 or
RIFLE – F
5
(6%)
S11
Online Supplementary Material
Table S7: Otherwise eligible abdominal surgery studies (35 studies, 8558 patients) that were excluded from our primary analysis as
they involved specific additional AKI risk factors: non-renal abdominal transplant (all Orthotopic Liver Transplant – OLT, 24 studies),
Bariatric procedures (three studies), open Abdominal Aortic surgery (seven studies – one in ruptured aneurysms) and non-renal
Urological surgery (one study confined to cystectomy). Studies involving surgery on native or transplant kidneys were not considered.
Mortality by AKI/No AKI category is shown where available, in all instances mortality was greater in the presence of AKI. Data was
available on mortality by AKI status in 11 studies in Liver Transplantation where pooled Relative Risk of death in the presence of AKI
was 5.9 (3.5-10.0), Random Effects Model, I2=45.7%.
Study
Hilmi 2015 [40]
Karapanagiotou 2014
[41]
Lewandowska 2014
[42]
Leithead 2014 (Control
Group) [43]
Sirivatanauksorn 2014
[44]
Utsumi M 2013 [45]
Romano TG 2013 [46]
Narciso RC 2013 [47]
Hong SH 2012 [48]
Jeong TD 2012 [49]
Nadim 2012 [50]
Umbro 2011[51]
Wagener 2011 [52]
Kundakci 2010 [53]
Zhu 2010 [54]
Iglesias 2010 [55]
Setting
ALL
AKI
% AKI
AKI Criteria Mortality
AKI
K
1.4%
Mortality No
AKI
0.0%
Mortality
Measure
30d
OLT
425
221
52.0%
OLT
71
37
52.1%
A
21.6%
0.0%
30d
OLT
63
35
55.6%
R
OLT
301
169
56.1%
K
OLT
81
58
71.6%
R
19.0%
0.0%
Hospital
OLT
OLT
OLT
OLT
OLT
OLT
OLT
OLT
OLT
OLT
OLT
200
92
315
350
19
283
46
92
112
193
668
121
52
255
45
11
118
26
37
64
116
242
60.5%
56.5%
81.0%
12.9%
57.9%
41.7%
56.5%
40.2%
57.1%
60.1%
36.2%
R
A
A
R
R
R
R
R
R
A
A
11.6%
76.9%
2.5%
50.0%
Hospital
Hospital
33.3%
3.0%
30d
24.6%
8.5%
1y
5.4%
35.9%
15.5%
1.2%
1.8%
8.3%
0.0%
0.9%
30d
1y
28d
7d
S12
Online Supplementary Material
Portal 2010 [56]
Tinti 2010 [57]
Lee 2010 [58]
Hilmi 2010[59]
Neimann 2009 [60]
Rymarz 2009 [61]
Ferreira 2010 [62]
Cabezulo 2006 [63]
Thakar 2007[64]
Weingarten 2011 [65]
Weingarten 2013 [66]
Joung 2015 [67]
Bang 2014 [68]
van Beek 2014 [69]
Pirgakis 2014 [70]
Yue 2013 [71]
Kamitani 2011 [72]
Haglwara 2007 [73]
Tallgren 2007 [74]
OLT
OLT
OLT
OLT
OLT
OLT
OLT
OLT
Bariatric
Bariatric
Bariatric
Urology
(Cystectomy)
Aortic
Aortic
(Ruptured)
Aortic
Aortic
Aortic
Aortic
Aortic
80
44
431
100
45
99
708
184
504
340
1227
30
24
118
34
24
31
235
57
42
21
71
37.5%
54.5%
27.4%
34.0%
53.3%
31.3%
33.2%
31.0%
8.3%
6.2%
5.8%
A
R
R
R
R
A
R
R
R
A
A
238
91
38.2%
A
444
82
18.5%
A
362
267
73.8%
R
87
71
54
160
69
13
32
13
44
15
14.9%
45.1%
24.1%
27.5%
21.7%
A
R
A
R
R
22.8%
4.8%
0.0%
1.4%
3.2%
0.0%
0.0%
0.0%
30d
Hospital
30d
30d
6.3%
0.0%
Hospital
13.6%
6.7%
7.8%
0.0%
30d
Hospital
S13
Online Supplementary Material
Table S8. Rates of non-renal post-operative complications (defined within studies) of patients who developed post-operative AKI
compared to those that did not. (For citations see main manuscript)
Study
Description of
Complication
Total
number of
patients
829
Total number of
complications
Complication rate
in those with AKI
375
48
(71%)
75
(87%)
22
(22%)
10
(10%)
18
(18%)
5
(5%)
8
(10%)
30
(38%)
23
(8%)
18
(6%)
44
(15%)
17
(6%)
14
(5%)
36
(12%)
Kambakamba
Any Dindo-Clavien
scale complications
Slankamenac
Not defined
569
295
Haemorrhage
450
45
Anastomotic leak
450
21
Surgical site infection
450
71
Need for mechanical
ventilation
Re-intubation
450
11
642
33
Prolonged mechanical
ventilation
Mechanical wound
complication
Surgical infection
642
130
2341
53
2341
74
Pulmonary complications
2341
94
Cardiovascular
complications
Venous
thromboembolism
Gastrointestinal
complications
2341
47
2341
29
2341
98
Teixeira
Tomozawa
Vaught
Complication rate
in those without
AKI
327
(43%)
220
(46%)
23
(7%)
11
(3%)
53
(15%)
6
(2%)
25
(4%)
100
(18%)
30
(1%)
56
(3%)
50
(2%)
30
(1%)
15
(1%)
62
(3%)
P Value
0.003
<0.0001
<0.0001
0.005
0.521
0.064
0.049
<0.0001
<0.0083
<0.0083
<0.0083
<0.0083
<0.0083
<0.0083
S14
Online Supplementary Material
Table S9: Length of hospital stay of patients who developed post-operative AKI compared to
those that did not. (For citations see main manuscript)
Author
Length of stay of patients
without AKI
Mean(SD) or Median(IQR)
Causey
7.8
(5.8)
11
(9-16)
12
(7.1)
12
(11-16)
7
(6-9)
11
(9-16)
19
(14-29)
Kambakamba
Kim
Lee
Correa-Gallego
Slankamenac
Tomozawa
Length of stay of
patients with AKI
Mean(SD) or
Median(IQR)
12.9
(8.8)
18
(12-26.5)
18.7
(20.25)
14
(11-21)
8
(6-9)
18
(12-31)
26.5
(16-45)
p value
<0.001
<0.001
<0.001
<0.001
0.3
<0.001
0.0001
Figure S1. Diagram illustrating search strategy for selection of studies.
Acute Kidney
Injury
Abstracts
screened
for
inclusion
Incidence
Incidence OR
risk
AKI OR Acute renal failure
OR
acute kidney injury
Surgery
Opera on OR
surgery OR
major surgery
S15
Online Supplementary Material
Figure S2: Pooled incidence of AKI grouped surgical setting with comparison to AKI incidence in major abdominal
surgery settings with specific additional risk factors for AKI excluded from our primary analysis. There was no
significant difference between subgroups in our primary model (p=0.08) however when the primary analysis was
compared with excluded subgroups there was a significant difference in polled AKI incidence between these groups
(p<0.0001).
S16
Online Supplementary Material
Supplementary References
1.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup, (2004) Acute renal failure definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International
Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8: R204-212
2.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, (2007) Acute Kidney Injury Network: report of an
initiative to improve outcomes in acute kidney injury. Crit Care 11: R31
3.
Kidney Disease Improving Global Outcomes, (2012) KDIGO Clinical Practice Guideline for Acute Kidney Injury; Section 2: AKI
Definition. Kidney Int Suppl (2011) 2: 19-36
4.
Abelha FJ, Botelho M, Fernandes V, Barros H, (2009) Outcome and quality of life of patients with acute kidney injury after major
surgery. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia 29: 404-414
5.
Abelha FJ, Botelho M, Fernandes V, Barros H, (2009) Determinants of postoperative acute kidney injury. Crit Care 13: R79
6.
Argalious MY, Dalton JE, Sreenivasalu T, O'Hara J, Sessler DI, (2013) The association of preoperative statin use and acute kidney
injury after noncardiac surgery. Anesth Analg 117: 916-923
7.
Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY, (2009) Identification of specific quality improvement opportunities for
the elderly undergoing gastrointestinal surgery. Arch Surg 144: 1013-1020
8.
Bihorac A, Brennan M, Ozrazgat-Baslanti T, Bozorgmehri S, Efron PA, Moore FA, Segal MS, Hobson CE, (2013) National surgical
quality improvement program underestimates the risk associated with mild and moderate postoperative acute kidney injury.
Critical care medicine 41: 2570-2583
9.
Chung CU, Nelson JA, Fischer JP, Wink JD, Serletti JM, Kovach SJ, (2015) Acute kidney injury after open ventral hernia repair: an
analysis of the 2005-2012 ACS-NSQIP datasets. Hernia
10.
Eachempati SR, Wang JC, Hydo LJ, Shou J, Barie PS, (2007) Acute renal failure in critically ill surgical patients: persistent lethality
despite new modes of renal replacement therapy. The Journal of trauma 63: 987-993
S17
Online Supplementary Material
11.
Endo A, Uchino S, Iwai K, Saito K, Sanui M, Takinami M, Uezono S, (2012) Intraoperative hydroxyethyl starch 70/0.5 is not related
to acute kidney injury in surgical patients: retrospective cohort study. Anesth Analg 115: 1309-1314
12.
Garg AX, Kurz A, Sessler DI, Cuerden M, Robinson A, Mrkobrada M, Parikh CR, Mizera R, Jones PM, Tiboni M, Font A, Cegarra V,
Gomez MF, Meyhoff CS, VanHelder T, Chan MT, Torres D, Parlow J, Clanchet Mde N, Amir M, Bidgoli SJ, Pasin L, Martinsen K,
Malaga G, Myles P, Acedillo R, Roshanov PS, Walsh M, Dresser G, Kumar P, Fleischmann E, Villar JC, Painter T, Biccard B, Bergese
S, Srinathan S, Cata JP, Chan V, Mehra B, Wijeysundera DN, Leslie K, Forget P, Whitlock R, Yusuf S, Devereaux PJ, (2014)
Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial. Jama 312: 2254-2264
13.
Giustiniano E, Meco M, Morenghi E, Ruggieri N, Cosseta D, Cirri S, Difrancesco O, Zito PC, Gollo Y, Raimondi F, (2014) May Renal
Resistive Index be an early predictive tool of postoperative complications in major surgery? Preliminary results. Biomed Res Int
2014: 917985
14.
Glance LG, Wissler R, Mukamel DB, Li Y, Diachun CA, Salloum R, Fleming FJ, Dick AW, (2010) Perioperative outcomes among
patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 113: 859-872
15.
Gocze I, Koch M, Renner P, Zeman F, Graf BM, Dahlke MH, Nerlich M, Schlitt HJ, Kellum JA, Bein T, (2015) Urinary biomarkers
TIMP-2 and IGFBP7 early predict acute kidney injury after major surgery. PLoS One 10: e0120863
16.
Harris DG, McCrone MP, Koo G, Weltz AS, Chiu WC, Scalea TM, Diaz JJ, Lissauer ME, (2015) Epidemiology and outcomes of acute
kidney injury in critically ill surgical patients. Journal of critical care 30: 102-106
17.
Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, Moldawer LL, Segal MS, Bihorac A, (2014) Cost
and Mortality Associated With Postoperative Acute Kidney Injury. Annals of surgery
18.
Kelz RR, Reinke CE, Zubizarreta JR, Wang M, Saynisch P, Even-Shoshan O, Reese PP, Fleisher LA, Silber JH, (2013) Acute kidney
injury, renal function, and the elderly obese surgical patient: a matched case-control study. Annals of surgery 258: 359-363
19.
Kim M, Brady JE, Li G, (2015) Interaction Effects of Acute Kidney Injury, Acute Respiratory Failure, and Sepsis on 30-Day
Postoperative Mortality in Patients Undergoing -High-Risk Intraabdominal General Surgical Procedures. Anesth Analg
20.
Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA, (2008) Case mix, outcome and activity for patients with severe acute
kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models
from a secondary analysis of the ICNARC Case Mix Programme database. Crit Care 12 Suppl 1: S2
S18
Online Supplementary Material
21.
Korenkevych D, Ozrazgat-Baslanti T, Thottakkara P, Hobson CE, Pardalos P, Momcilovic P, Bihorac A, (2015) The Pattern of
Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery. Annals of surgery
22.
Lidsky ME, Thacker JK, Lagoo-Deenadayalan SA, Scarborough JE, (2012) Advanced age is an independent predictor for increased
morbidity and mortality after emergent surgery for diverticulitis. Surgery 152: 465-472
23.
Lo N, Kotsia A, Christopoulos G, Roesle M, Rangan BV, Kim BJ, Webb A, Banerjee S, Brilakis ES, (2014) Perioperative
complications after noncardiac surgery in patients with insertion of second-generation drug-eluting stents. Am J Cardiol 114:
230-235
24.
McNicol L, Story DA, Leslie K, Myles PS, Fink M, Shelton AC, Clavisi O, Poustie SJ, (2007) Postoperative complications and
mortality in older patients having non-cardiac surgery at three Melbourne teaching hospitals. Med J Aust 186: 447-452
25.
Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, Blumgart LH, (1998) Perioperative outcomes of major hepatic
resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal
dysfunction. Journal of the American College of Surgeons 187: 620-625
26.
Molnar AO, Coca SG, Devereaux PJ, Jain AK, Kitchlu A, Luo J, Parikh CR, Paterson JM, Siddiqui N, Wald R, Walsh M, Garg AX, (2011)
Statin use associates with a lower incidence of acute kidney injury after major elective surgery. J Am Soc Nephrol 22: 939-946
27.
Nash DM, Mustafa RA, McArthur E, Wijeysundera DN, Paterson JM, Sharan S, Vinden C, Wald R, Welk B, Sessler DI, Devereaux PJ,
Walsh M, Garg AX, (2015) Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort
study. Can J Anaesth 62: 356-368
28.
Rhodes A, Moreno RP, Metnitz B, Hochrieser H, Bauer P, Metnitz P, (2011) Epidemiology and outcome following post-surgical
admission to critical care. Intensive care medicine 37: 1466-1472
29.
Sabate S, Gomar C, Canet J, Sierra P, Castillo J, (2011) [Risk factors for postoperative acute kidney injury in a cohort of 2378
patients from 59 hospitals]. Rev Esp Anestesiol Reanim 58: 548-555
30.
Saze Z, Miyata H, Konno H, Gotoh M, Anazawa T, Tomotaki A, Wakabayashi G, Mori M, (2015) Risk Models of Operative
Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database. Medicine (Baltimore) 94: e1224
S19
Online Supplementary Material
31.
Slankamenac K, Beck-Schimmer B, Breitenstein S, Puhan MA, Clavien PA, (2013) Novel prediction score including pre- and
intraoperative parameters best predicts acute kidney injury after liver surgery. World J Surg 37: 2618-2628
32.
Spolverato G, Ejaz A, Hyder O, Kim Y, Pawlik TM, (2014) Failure to rescue as a source of variation in hospital mortality after
hepatic surgery. The British journal of surgery 101: 836-846
33.
Story DA, Leslie K, Myles PS, Fink M, Poustie SJ, Forbes A, Yap S, Beavis V, Kerridge R, (2010) Complications and mortality in older
surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia
65: 1022-1030
34.
Tadlock MD, Karamanos E, Skiada D, Inaba K, Talving P, Senagore A, Demetriades D, (2013) Emergency surgery for acute
diverticulitis: which operation? A National Surgical Quality Improvement Program study. The journal of trauma and acute care
surgery 74: 1385-1391; quiz 1610
35.
Tagawa M, Ogata A, Hamano T, (2015) Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System
Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study. PLoS
One 10: e0132507
36.
Vaara ST, Pettila V, Kaukonen KM, Bendel S, Korhonen AM, Bellomo R, Reinikainen M, (2014) The attributable mortality of acute
kidney injury: a sequentially matched analysis*. Critical care medicine 42: 878-885
37.
Wakeam E, Hyder JA, Jiang W, Lipsitz SA, Finlayson S, (2015) Risk and patterns of secondary complications in surgical inpatients.
JAMA Surg 150: 65-73
38.
Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI, (2013) Relationship between
intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of
hypotension. Anesthesiology 119: 507-515
39.
Walsh M, Garg AX, Devereaux PJ, Argalious M, Honar H, Sessler DI, (2013) The association between perioperative hemoglobin and
acute kidney injury in patients having noncardiac surgery. Anesth Analg 117: 924-931
40.
Hilmi IA, Damian D, Al-Khafaji A, Planinsic R, Boucek C, Sakai T, Chang CC, Kellum JA, (2015) Acute kidney injury following
orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes. British journal of anaesthesia
114: 919-926
S20
Online Supplementary Material
41.
Karapanagiotou A, Dimitriadis C, Papadopoulos S, Kydona C, Kefsenidis S, Papanikolaou V, Gritsi-Gerogianni N, (2014)
Comparison of RIFLE and AKIN criteria in the evaluation of the frequency of acute kidney injury in post-liver transplantation
patients. Transplant Proc 46: 3222-3227
42.
Lewandowska L, Matuszkiewicz-Rowinska J, Jayakumar C, Oldakowska-Jedynak U, Looney S, Galas M, Dutkiewicz M, Krawczyk M,
Ramesh G, (2014) Netrin-1 and semaphorin 3A predict the development of acute kidney injury in liver transplant patients. PLoS
One 9: e107898
43.
Leithead JA, Armstrong MJ, Corbett C, Andrew M, Kothari C, Gunson BK, Mirza D, Muiesan P, Ferguson JW, (2014) Split liver
transplant recipients do not have an increased frequency of acute kidney injury. Transpl Int 27: 1125-1134
44.
Sirivatanauksorn Y, Parakonthun T, Premasathian N, Limsrichamrern S, Mahawithitwong P, Kositamongkol P, Tovikkai C,
Asavakarn S, (2014) Renal dysfunction after orthotopic liver transplantation. Transplant Proc 46: 818-821
45.
Utsumi M, Umeda Y, Sadamori H, Nagasaka T, Takaki A, Matsuda H, Shinoura S, Yoshida R, Nobuoka D, Satoh D, Fuji T, Yagi T,
Fujiwara T, (2013) Risk factors for acute renal injury in living donor liver transplantation: evaluation of the RIFLE criteria.
Transpl Int 26: 842-852
46.
Romano TG, Schmidtbauer I, Silva FM, Pompilio CE, D'Albuquerque LA, Macedo E, (2013) Role of MELD score and serum
creatinine as prognostic tools for the development of acute kidney injury after liver transplantation. PLoS One 8: e64089
47.
Narciso RC, Ferraz LR, Mies S, Monte JC, dos Santos OF, Neto MC, Rodrigues CJ, Batista MC, Durao MS, Jr., (2013) Impact of acute
kidney injury exposure period among liver transplantation patients. BMC nephrology 14: 43
48.
Hong SH, Park CO, Park CS, (2012) Prediction of newly developed acute renal failure using serum phosphorus concentrations
after living-donor liver transplantation. J Int Med Res 40: 2199-2212
49.
Jeong TD, Kim S, Lee W, Song GW, Kim YK, Chun S, Lee SG, Min WK, (2012) Neutrophil gelatinase-associated lipocalin as an early
biomarker of acute kidney injury in liver transplantation. Clin Transplant 26: 775-781
50.
Nadim MK, Genyk YS, Tokin C, Fieber J, Ananthapanyasut W, Ye W, Selby R, (2012) Impact of the etiology of acute kidney injury
on outcomes following liver transplantation: acute tubular necrosis versus hepatorenal syndrome. Liver Transpl 18: 539-548
S21
Online Supplementary Material
51.
Umbro I, Tinti F, Mordenti M, Rossi M, Ianni S, Pugliese F, Ruberto F, Ginanni Corradini S, Nofroni I, Poli L, Berloco PB, Mitterhofer
AP, (2011) Model for end-stage liver disease score versus simplified acute physiology score criteria in acute renal failure after
liver transplantation. Transplant Proc 43: 1139-1141
52.
Wagener G, Minhaz M, Mattis FA, Kim M, Emond JC, Lee HT, (2011) Urinary neutrophil gelatinase-associated lipocalin as a marker
of acute kidney injury after orthotopic liver transplantation. Nephrol Dial Transplant 26: 1717-1723
53.
Kundakci A, Pirat A, Komurcu O, Torgay A, Karakayali H, Arslan G, Haberal M, (2010) Rifle criteria for acute kidney dysfunction
following liver transplantation: incidence and risk factors. Transplant Proc 42: 4171-4174
54.
Zhu M, Li Y, Xia Q, Wang S, Qiu Y, Che M, Dai H, Qian J, Ni Z, Axelsson J, Yan Y, (2010) Strong impact of acute kidney injury on
survival after liver transplantation. Transplant Proc 42: 3634-3638
55.
Iglesias JI, DePalma JA, Levine JS, (2010) Risk factors for acute kidney injury following orthotopic liver transplantation: the
impact of changes in renal function while patients await transplantation. BMC nephrology 11: 30
56.
Portal AJ, McPhail MJ, Bruce M, Coltart I, Slack A, Sherwood R, Heaton ND, Shawcross D, Wendon JA, Heneghan MA, (2010)
Neutrophil gelatinase--associated lipocalin predicts acute kidney injury in patients undergoing liver transplantation. Liver
Transpl 16: 1257-1266
57.
Tinti F, Umbro I, Mecule A, Rossi M, Merli M, Nofroni I, Corradini SG, Poli L, Pugliese F, Ruberto F, Berloco PB, Mitterhofer AP,
(2010) RIFLE criteria and hepatic function in the assessment of acute renal failure in liver transplantation. Transplant Proc 42:
1233-1236
58.
Lee JP, Heo NJ, Joo KW, Yi NJ, Suh KS, Moon KC, Kim SG, Kim YS, (2010) Risk factors for consequent kidney impairment and
differential impact of liver transplantation on renal function. Nephrol Dial Transplant 25: 2772-2785
59.
Hilmi IA, Peng Z, Planinsic RM, Damian D, Dai F, Tyurina YY, Kagan VE, Kellum JA, (2010) N-acetylcysteine does not prevent
hepatorenal ischaemia-reperfusion injury in patients undergoing orthotopic liver transplantation. Nephrol Dial Transplant 25:
2328-2333
60.
Niemann CU, Walia A, Waldman J, Davio M, Roberts JP, Hirose R, Feiner J, (2009) Acute kidney injury during liver transplantation
as determined by neutrophil gelatinase-associated lipocalin. Liver Transpl 15: 1852-1860
S22
Online Supplementary Material
61.
Rymarz A, Serwacki M, Rutkowski M, Pakosinski K, Grodzicki M, Patkowski W, Kacka A, Oldakowska-Jedynak U, Krawczyk M,
(2009) Prevalence and predictors of acute renal injury in liver transplant recipients. Transplant Proc 41: 3123-3125
62.
Ferreira AC, Nolasco F, Carvalho D, Sampaio S, Baptista A, Pessegueiro P, Monteiro E, Mourao L, Barroso E, (2010) Impact of
RIFLE classification in liver transplantation. Clin Transplant 24: 394-400
63.
Cabezuelo JB, Ramirez P, Rios A, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Bueno FS, Robles R, Parrilla P, (2006)
Risk factors of acute renal failure after liver transplantation. Kidney Int 69: 1073-1080
64.
Thakar CV, Kharat V, Blanck S, Leonard AC, (2007) Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol 2: 426430
65.
Weingarten TN, Swain JM, Kendrick ML, Charlton MR, Schroeder BJ, Lee RE, Narr BJ, Ribeiro TC, Schroeder DR, Sprung J, (2011)
Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obes Surg 21: 17141720
66.
Weingarten TN, Gurrieri C, McCaffrey JM, Ricter SJ, Hilgeman ML, Schroeder DR, Kendrick ML, Greene EL, Sprung J, (2013) Acute
kidney injury following bariatric surgery. Obes Surg 23: 64-70
67.
Joung KW, Choi SS, Kong YG, Yu J, Lim J, Hwang JH, Kim YK, (2015) Incidence and Risk Factors of Acute Kidney Injury after Radical
Cystectomy: Importance of Preoperative Serum Uric Acid Level. Int J Med Sci 12: 599-604
68.
Bang JY, Lee JB, Yoon Y, Seo HS, Song JG, Hwang GS, (2014) Acute kidney injury after infrarenal abdominal aortic aneurysm
surgery: a comparison of AKIN and RIFLE criteria for risk prediction. British journal of anaesthesia 113: 993-1000
69.
van Beek SC, Legemate DA, Vahl A, Bouman CS, Vogt L, Wisselink W, Balm R, (2014) Acute kidney injury defined according to the
'Risk,' 'Injury,' 'Failure,' 'Loss,' and 'End-stage' (RIFLE) criteria after repair for a ruptured abdominal aortic aneurysm. Journal of
vascular surgery 60: 1159-1167, 1167 e1151
70.
Pirgakis KM, Makris K, Dalainas I, Lazaris AM, Maltezos CK, Liapis CD, (2014) Urinary cystatin C as an early biomarker of acute
kidney injury after open and endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 28: 1649-1658
S23
Online Supplementary Material
71.
Yue JN, Luo Z, Guo DQ, Xu X, Chen B, Jiang JH, Yang J, Shi ZY, Zhu T, Ju MJ, Tu GW, Wang YQ, Zhu DM, Fu WG, (2013) Evaluation of
acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing
abdominal aortic aneurysm repair. Chin Med J (Engl) 126: 431-436
72.
Kamitani K, Yoshida H, Arai R, Ito H, Miyoshi H, Takebe M, Komiya R, Matsuura K, (2011) [Examination of acute kidney injury
after abdominal aortic aneurysm surgery]. Masui 60: 686-691
73.
Hagiwara S, Saima S, Negishi K, Takeda R, Miyauchi N, Akiyama Y, Horikoshi S, Tomino Y, (2007) High incidence of renal failure in
patients with aortic aneurysms. Nephrol Dial Transplant 22: 1361-1368
74.
Tallgren M, Niemi T, Poyhia R, Raininko E, Railo M, Salmenpera M, Lepantalo M, Hynninen M, (2007) Acute renal injury and
dysfunction following elective abdominal aortic surgery. Eur J Vasc Endovasc Surg 33: 550-555
S24