Renal disease and the surgical patient: Minimizing the impact

Article Figures & Data

TABLE 1

Criteria for chronic kidney disease

Markers of kidney damage
(≥ 1 present for > 3 months)

Albuminuria
(albumin excretion rate ≥ 30 mg/day; albumin-creatinine ratio ≥ 30 mg/g)

Urinary sediment abnormalities

Electrolyte and other abnormalities due to tubular disorders

Abnormalities detected by histology

Structural abnormalities detected by imaging

History of kidney transplant

Decreased glomerular filtration rate (GFR)
(present for > 3 months)

GFR < 60 mL/min/1.73 m² (GFR categories G3a to G5)

Reprinted from Kidney International Supplements, 3:19–62, KDIGO. Chapter 1: definition and classification of CKD, copyright 2013, doi:10.1038/kisup.2012.64, with permission from Elsevier.

TABLE 2

Defining the severity of chronic kidney disease

Stage	GFR, mL/min/1.73 m₂		Descriptor
G1	≥ 90		Normal or high
G2	60–89		Mildly decreased^a
G3a	45–59		Mildly to moderately decreased
G3b	30–44		Moderately to severely decreased
G4	15–29		Severely decreased
G5	< 15		Kidney failure
Albuminuria	AER, mg/day	ACR, mg/g	Descriptor

A1	< 30	< 30	Normal to mildly increased
A2	30–300	30–300	Moderately increased^b
A3	> 300	> 300	Severely increased

↵a In the absence of evidence of kidney damage, neither GFR category G1 nor G2 meets the criteria for chronic kidney disease.
↵b Includes the nephrotic syndrome (AER usually > 2,200 mg/day).
ACR = albumin-creatinine ratio equivalent; AER = albumin excretion rate; GFR = glomerular filtration rate
Reprinted from Kidney International Supplements, 3:19–62, KDIGO. Chapter 1: definition and classification of CKD, copyright 2013, doi:10.1038/kisup.2012.64, with permission from Elsevier.

TABLE 3

Risk factors for acute kidney injury in surgical patients

Cardiac surgery	Noncardiac surgery
Patient factors
Age > 75	Age ≥ 59
Chronic kidney disease	Body mass index ≥ 32 kg/m²
Diabetes mellitus (type 1 > type 2)	Peripheral vascular occlusive disease
Anemia	Hepatic disease, especially chronic kidney disease
Congestive heart failure	Chronic obstructive pulmonary disease
Left ventricular dysfunction	African American race
Pulse pressure > 40 mm Hg	Hypertension
Prior myocardial infarction	Diabetes
Angiotensin-converting enzyme inhibitors (but evidence conflicting)
Surgical factors
Urgent surgery	Emergency surgery
Duration of procedure	High-risk surgery (intrathoracic, intraperitoneal, suprainguinal vascular, with potential for large blood loss or large fluid shifts)
Cardiopulmonary bypass > 2 hours
Intra-aortic balloon pump use	Total vasopressor dose
Multiple inotrope usec	Vasopressor infusion
Off-pump coronary artery bypass grafting (vs on-pump)	Diuretic administration