J Perioper Pract. 2025 Nov 27:17504589251390407. doi: 10.1177/17504589251390407. Online ahead of print.
ABSTRACT
INTRODUCTION: Identifying risk factors for acute kidney injury (AKI) following major non-cardiac surgery is challenging due to heterogeneous findings and variable relevance across published studies. This complexity hinders the development of a standardised prognostic model.
METHODS: A systematic review and meta-analysis were conducted based on an extensive literature search (2002-2022) in PubMed, Scopus, Web of Science, Cochrane Central, LILACS, and Dart Europe. Studies were independently screened and selected, with extraction of relevant preoperative and intraoperative variables. Meta-analysis was performed using RevMan 5.4.
RESULTS: Out of 533 studies, ten met inclusion criteria. Significant risk factors for postoperative AKI included diabetes mellitus (OR: 1.65, CI: 1.20-2.27), hypertension (OR: 1.86, CI: 1.36-2.54), ACE inhibitors or ARBs use (OR: 1.76, CI: 1.48-2.09), ischaemic heart disease (OR: 1.93, CI: 1.55-2.41), and male sex (OR: 1.28, CI: 1.07-1.53). Protective factors were female sex (OR: 0.72, CI: 0.54-0.96) and higher preoperative haemoglobin (MD: -0.41, CI: -0.52 to -0.30). Trends without statistical significance were noted for older age, low glomerular filtration rate, prolonged operative time, and higher serum creatinine.
CONCLUSIONS: Comorbidities and certain pharmacological treatments significantly elevate postoperative AKI risk. These findings underscore the need for vigilant preoperative risk stratification.PROSPERO registration:CRD420251111455.
PMID:41307212 | DOI:10.1177/17504589251390407
