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

J.F. Mooney, I. Ranasinghe, C.K. Chow, V. Perkovic, F. Barzi, S. Zoungas, M.J. Holzmann, G.M. Welten, F. Biancari, V.C. Wu, T.C. Tan, A. Cass, Graham Hillis

    Research output: Contribution to journalReview article

    47 Citations (Scopus)

    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 ml·min·1.73 m 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 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·1.73 m the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m 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 and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml·min·1.73 m. CONCLUSION:: There is a powerful relationship between eGFR, and both short-and long-term prognosis after, predominantly cardiac and vascular, surgery. © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.
    Original languageEnglish
    Pages (from-to)809-824
    JournalAnesthesiology
    Volume118
    Issue number4
    DOIs
    Publication statusPublished - 2013

    Fingerprint

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

    Cite this

    Mooney, J.F. ; Ranasinghe, I. ; Chow, C.K. ; Perkovic, V. ; Barzi, F. ; Zoungas, S. ; Holzmann, M.J. ; Welten, G.M. ; Biancari, F. ; Wu, V.C. ; Tan, T.C. ; Cass, A. ; 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.
    @article{89065b5f89da44a880281f3278f8fbdc,
    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 ml·min·1.73 m 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 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·1.73 m the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m 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 and 3.75 (95{\%} CI 3.44-4.08) in those with an eGFR less than 15 ml·min·1.73 m. CONCLUSION:: There is a powerful relationship between eGFR, and both short-and long-term prognosis after, predominantly cardiac and vascular, surgery. {\circledC} 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.",
    author = "J.F. Mooney and I. Ranasinghe and C.K. Chow and V. Perkovic and F. Barzi and S. Zoungas and M.J. Holzmann and G.M. Welten and F. Biancari and V.C. Wu and T.C. Tan and A. Cass and Graham Hillis",
    year = "2013",
    doi = "10.1097/ALN.0b013e318287b72c",
    language = "English",
    volume = "118",
    pages = "809--824",
    journal = "Anethesiology",
    issn = "0003-3022",
    publisher = "Lippincott Williams & Wilkins",
    number = "4",

    }

    Mooney, JF, Ranasinghe, I, Chow, CK, Perkovic, V, Barzi, F, Zoungas, S, Holzmann, MJ, Welten, GM, Biancari, F, Wu, VC, Tan, TC, 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, J.F.; Ranasinghe, I.; Chow, C.K.; Perkovic, V.; Barzi, F.; Zoungas, S.; Holzmann, M.J.; Welten, G.M.; Biancari, F.; Wu, V.C.; Tan, T.C.; Cass, A.; Hillis, Graham.

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

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: A systematic review and meta-analysis

    AU - Mooney, J.F.

    AU - Ranasinghe, I.

    AU - Chow, C.K.

    AU - Perkovic, V.

    AU - Barzi, F.

    AU - Zoungas, S.

    AU - Holzmann, M.J.

    AU - Welten, G.M.

    AU - Biancari, F.

    AU - Wu, V.C.

    AU - Tan, T.C.

    AU - Cass, A.

    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 ml·min·1.73 m 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 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·1.73 m the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m 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 and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml·min·1.73 m. CONCLUSION:: There is a powerful relationship between eGFR, and both short-and long-term prognosis after, predominantly cardiac and vascular, surgery. © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.

    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 ml·min·1.73 m 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 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·1.73 m the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m 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 and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml·min·1.73 m. CONCLUSION:: There is a powerful relationship between eGFR, and both short-and long-term prognosis after, predominantly cardiac and vascular, surgery. © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.

    U2 - 10.1097/ALN.0b013e318287b72c

    DO - 10.1097/ALN.0b013e318287b72c

    M3 - Review article

    VL - 118

    SP - 809

    EP - 824

    JO - Anethesiology

    JF - Anethesiology

    SN - 0003-3022

    IS - 4

    ER -