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 m l · min · 1.73 m(-2) 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(-2) 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 · 1.73m(-2) the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml · min · 1.73 m(-2) 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(-2) and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml · min · 1.73 m(-2).
  
  
  CONCLUSIONS
  : There is a powerful relationship between eGFR, and both short- and long-term prognosis after, predominantly cardiac and vascular, surgery.
authors: The George Institute for Global Health, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050 Australia. jmooney@georgeinstitute.org.au
authors: John F
authors: JF
authors: Mooney
authors: Isuru
authors: I
authors: Ranasinghe
authors: Clara K
authors: CK
authors: Chow
authors: Vlado
authors: V
authors: Perkovic
authors: Federica
authors: F
authors: Barzi
authors: Sophia
authors: S
authors: Zoungas
authors: Martin J
authors: MJ
authors: Holzmann
authors: Gijs M
authors: GM
authors: Welten
authors: Fausto
authors: F
authors: Biancari
authors: Vin-Cent
authors: VC
authors: Wu
authors: Timothy C
authors: TC
authors: Tan
authors: Alan
authors: A
authors: Cass
authors: Graham S
authors: GS
authors: Hillis
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk
chemical_list: D003404:Creatinine