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

    51 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

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