Importance of intraoperative oliguria during major abdominal surgery

findings of the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery trial

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The association between intraoperative oliguria during major abdominal surgery and the subsequent development of postoperative acute kidney injury (AKI) remains poorly defined. We hypothesised that, in such patients, intraoperative oliguria would be an independent predictor of subsequent AKI. Methods: We performed a post hoc analysis of data from the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of conservative vs liberal fluid therapy during and after major abdominal surgery. We used χ 2 , logistic regression, and fractional polynomials to study the association between intraoperative oliguria defined as a urinary output <0.5 ml kg −1 h −1 and the development of postoperative AKI defined by the Kidney Disease Improving Global Outcomes consensus criteria. Results: We included 2444 of 2983 patients from the RELIEF trial in this study. A total of 889 patients (36%) met oliguric criteria intraoperatively. Oliguria occurred in 35% of those without AKI, and 44%, 48%, and 45% of those who developed postoperative AKI Stages 1–3, respectively (P<0.001 for trend). Intraoperative oliguria was associated with an increased risk of AKI, risk ratio: 1.38 (95% confidence interval: 1.14–1.44; P<0.001), but greater intensity of oliguria (urine output <0.3 ml kg −1 h −1 ) did not increase this risk further. Most patients with oliguria did not develop AKI; the positive predictive value of oliguria was 25.5%, and the negative predictive value was 81.6%. Conclusions: Intraoperative oliguria, defined as urine output <0.5 ml kg −1 h −1 , was relatively common and was associated with postoperative AKI. However, the predictive utility of oliguria for AKI was low, whilst its absence had a good predictive value for an AKI-free postoperative course. Clinical trial registration: NCT01424150.

Original languageEnglish
Pages (from-to) 726-733
Number of pages8
JournalBritish Journal of Anaesthesia
Volume122
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • acute kidney injury
  • creatinine
  • fluids
  • oliguria
  • renal replacement therapy
  • surgery

Cite this

@article{d57fc4dbf9b74b2cace0e1aa045f64b0,
title = "Importance of intraoperative oliguria during major abdominal surgery: findings of the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery trial",
abstract = "Background: The association between intraoperative oliguria during major abdominal surgery and the subsequent development of postoperative acute kidney injury (AKI) remains poorly defined. We hypothesised that, in such patients, intraoperative oliguria would be an independent predictor of subsequent AKI. Methods: We performed a post hoc analysis of data from the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of conservative vs liberal fluid therapy during and after major abdominal surgery. We used χ 2 , logistic regression, and fractional polynomials to study the association between intraoperative oliguria defined as a urinary output <0.5 ml kg −1 h −1 and the development of postoperative AKI defined by the Kidney Disease Improving Global Outcomes consensus criteria. Results: We included 2444 of 2983 patients from the RELIEF trial in this study. A total of 889 patients (36{\%}) met oliguric criteria intraoperatively. Oliguria occurred in 35{\%} of those without AKI, and 44{\%}, 48{\%}, and 45{\%} of those who developed postoperative AKI Stages 1–3, respectively (P<0.001 for trend). Intraoperative oliguria was associated with an increased risk of AKI, risk ratio: 1.38 (95{\%} confidence interval: 1.14–1.44; P<0.001), but greater intensity of oliguria (urine output <0.3 ml kg −1 h −1 ) did not increase this risk further. Most patients with oliguria did not develop AKI; the positive predictive value of oliguria was 25.5{\%}, and the negative predictive value was 81.6{\%}. Conclusions: Intraoperative oliguria, defined as urine output <0.5 ml kg −1 h −1 , was relatively common and was associated with postoperative AKI. However, the predictive utility of oliguria for AKI was low, whilst its absence had a good predictive value for an AKI-free postoperative course. Clinical trial registration: NCT01424150.",
keywords = "acute kidney injury, creatinine, fluids, oliguria, renal replacement therapy, surgery",
author = "Myles, {Paul S.} and McIlroy, {David R.} and Rinaldo Bellomo and Sophie Wallace",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.bja.2019.01.010",
language = "English",
volume = "122",
pages = "726--733",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Importance of intraoperative oliguria during major abdominal surgery

T2 - findings of the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery trial

AU - Myles, Paul S.

AU - McIlroy, David R.

AU - Bellomo, Rinaldo

AU - Wallace, Sophie

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: The association between intraoperative oliguria during major abdominal surgery and the subsequent development of postoperative acute kidney injury (AKI) remains poorly defined. We hypothesised that, in such patients, intraoperative oliguria would be an independent predictor of subsequent AKI. Methods: We performed a post hoc analysis of data from the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of conservative vs liberal fluid therapy during and after major abdominal surgery. We used χ 2 , logistic regression, and fractional polynomials to study the association between intraoperative oliguria defined as a urinary output <0.5 ml kg −1 h −1 and the development of postoperative AKI defined by the Kidney Disease Improving Global Outcomes consensus criteria. Results: We included 2444 of 2983 patients from the RELIEF trial in this study. A total of 889 patients (36%) met oliguric criteria intraoperatively. Oliguria occurred in 35% of those without AKI, and 44%, 48%, and 45% of those who developed postoperative AKI Stages 1–3, respectively (P<0.001 for trend). Intraoperative oliguria was associated with an increased risk of AKI, risk ratio: 1.38 (95% confidence interval: 1.14–1.44; P<0.001), but greater intensity of oliguria (urine output <0.3 ml kg −1 h −1 ) did not increase this risk further. Most patients with oliguria did not develop AKI; the positive predictive value of oliguria was 25.5%, and the negative predictive value was 81.6%. Conclusions: Intraoperative oliguria, defined as urine output <0.5 ml kg −1 h −1 , was relatively common and was associated with postoperative AKI. However, the predictive utility of oliguria for AKI was low, whilst its absence had a good predictive value for an AKI-free postoperative course. Clinical trial registration: NCT01424150.

AB - Background: The association between intraoperative oliguria during major abdominal surgery and the subsequent development of postoperative acute kidney injury (AKI) remains poorly defined. We hypothesised that, in such patients, intraoperative oliguria would be an independent predictor of subsequent AKI. Methods: We performed a post hoc analysis of data from the Restrictive Versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of conservative vs liberal fluid therapy during and after major abdominal surgery. We used χ 2 , logistic regression, and fractional polynomials to study the association between intraoperative oliguria defined as a urinary output <0.5 ml kg −1 h −1 and the development of postoperative AKI defined by the Kidney Disease Improving Global Outcomes consensus criteria. Results: We included 2444 of 2983 patients from the RELIEF trial in this study. A total of 889 patients (36%) met oliguric criteria intraoperatively. Oliguria occurred in 35% of those without AKI, and 44%, 48%, and 45% of those who developed postoperative AKI Stages 1–3, respectively (P<0.001 for trend). Intraoperative oliguria was associated with an increased risk of AKI, risk ratio: 1.38 (95% confidence interval: 1.14–1.44; P<0.001), but greater intensity of oliguria (urine output <0.3 ml kg −1 h −1 ) did not increase this risk further. Most patients with oliguria did not develop AKI; the positive predictive value of oliguria was 25.5%, and the negative predictive value was 81.6%. Conclusions: Intraoperative oliguria, defined as urine output <0.5 ml kg −1 h −1 , was relatively common and was associated with postoperative AKI. However, the predictive utility of oliguria for AKI was low, whilst its absence had a good predictive value for an AKI-free postoperative course. Clinical trial registration: NCT01424150.

KW - acute kidney injury

KW - creatinine

KW - fluids

KW - oliguria

KW - renal replacement therapy

KW - surgery

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U2 - 10.1016/j.bja.2019.01.010

DO - 10.1016/j.bja.2019.01.010

M3 - Article

VL - 122

SP - 726

EP - 733

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 6

ER -