Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery:

A Systematic Review and Meta-analysis

John Mooney, I Ranasinghe, Clara Chow, Vlado Perkovic, Federica Barzi, Sophia Zoungas, Martin Holzmann, Gijs Welten, Fausto Biancari, Vin-Cent Wu, Timothy Tan, Alan Cass, Graham Hillis

Research output: Contribution to journalArticleResearchpeer-review

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 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.
Original languageEnglish
Pages (from-to)809-824
Number of pages16
JournalAnesthesiology
Volume118
Issue number4
DOIs
Publication statusPublished - 2013
Externally publishedYes

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Glomerular Filtration Rate
Meta-Analysis
Confidence Intervals
Acute Kidney Injury
Thoracic Surgery
Blood Vessels
Mortality
Ambulatory Surgical Procedures
Cohort Studies
Kidney

Cite this

Mooney, John ; Ranasinghe, I ; Chow, Clara ; Perkovic, Vlado ; Barzi, Federica ; Zoungas, Sophia ; Holzmann, Martin ; Welten, Gijs ; Biancari, Fausto ; Wu, Vin-Cent ; Tan, Timothy ; Cass, Alan ; Hillis, Graham. / Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery: A Systematic Review and Meta-analysis. In: Anesthesiology. 2013 ; Vol. 118, No. 4. pp. 809-824.
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title = "Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery:: A Systematic Review and Meta-analysis",
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 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.",
author = "John Mooney and I Ranasinghe and Clara Chow and Vlado Perkovic and Federica Barzi and Sophia Zoungas and Martin Holzmann and Gijs Welten and Fausto Biancari and Vin-Cent Wu and Timothy Tan and Alan Cass and Graham Hillis",
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language = "English",
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Mooney, J, Ranasinghe, I, Chow, C, Perkovic, V, Barzi, F, Zoungas, S, Holzmann, M, Welten, G, Biancari, F, Wu, V-C, Tan, T, Cass, A & Hillis, G 2013, 'Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery: A Systematic Review and Meta-analysis', Anesthesiology, vol. 118, no. 4, pp. 809-824. https://doi.org/10.1097/ALN.0b013e318287b72c

Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery: A Systematic Review and Meta-analysis. / Mooney, John; Ranasinghe, I; Chow, Clara; Perkovic, Vlado; Barzi, Federica; Zoungas, Sophia; Holzmann, Martin; Welten, Gijs; Biancari, Fausto; Wu, Vin-Cent; Tan, Timothy; Cass, Alan; Hillis, Graham.

In: Anesthesiology, Vol. 118, No. 4, 2013, p. 809-824.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery:

T2 - A Systematic Review and Meta-analysis

AU - Mooney, John

AU - Ranasinghe, I

AU - Chow, Clara

AU - Perkovic, Vlado

AU - Barzi, Federica

AU - Zoungas, Sophia

AU - Holzmann, Martin

AU - Welten, Gijs

AU - Biancari, Fausto

AU - Wu, Vin-Cent

AU - Tan, Timothy

AU - Cass, Alan

AU - Hillis, Graham

PY - 2013

Y1 - 2013

N2 - 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 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.

AB - 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 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.

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U2 - 10.1097/ALN.0b013e318287b72c

DO - 10.1097/ALN.0b013e318287b72c

M3 - Article

VL - 118

SP - 809

EP - 824

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 4

ER -