title: Is Preoperative Endothelial Dysfunction a Potentially Modifiable Risk Factor for Renal Injury Associated With Noncardiac Surgery?
abstract: OBJECTIVE
  To determine whether preoperative endothelial dysfunction provides risk stratification for perioperative renal injury in patients undergoing noncardiac surgery. The relationship between perioperative renal injury and myocardial injury after noncardiac surgery (MINS) was explored secondarily.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  A total of 218 patients scheduled to undergo intermediate or high-risk noncardiac surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  Endothelial dysfunction was identified preoperatively by a Reactive Hyperemia-Peripheral Arterial Tonometry (RH-PAT) index. Renal injury was defined by peak delta serum creatinine (ΔSCr) or creatinine-based kidney disease: Improving global outcomes acute kidney injury (AKI) criteria within 7 days postoperatively. MINS was defined by peak troponin ≥0.04 µg/L within 3 days postoperatively. AKI occurred in 22 patients (10.1%). Median RH-PAT index within the study cohort was 1.64 (range 1.03-4.96) and did not differ between patients with or without AKI. When adjusted for covariates, there was no association between RH-PAT index and either AKI or peak ΔSCr. MINS occurred in 32 patients (14.7%) and was associated independently with the outcome of AKI (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.2-10.8; p = 0.02) and peak ΔSCr (β-regression coefficient 23; 95% CI, 9-37; p = 0.002). Co-occurrence of AKI and MINS portended a marked increase in 30-day mortality (OR, 43; 95% CI, 6-305; p = 0.001) and delayed time to discharge (hazard ratio, 0.27; 95% CI, 0.13-0.54; p = 0.001).
  
  
  CONCLUSIONS
  For patients undergoing noncardiac surgery, preoperative endothelial function assessed by noninvasive peripheral arterial tonometry was not associated with perioperative AKI. Perioperative renal injury was associated strongly with MINS, and this may represent a mechanism by which AKI increases adverse outcomes.
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;; Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY;. Electronic address: D.Mcilroy@alfred.org.au.
authors.forename: David R
authors.initials: DR
authors.lastname: McIlroy
authors.affiliation: Department of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Matthew T V
authors.initials: MT
authors.lastname: Chan
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;
authors.forename: Sophie K
authors.initials: SK
authors.lastname: Wallace
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;
authors.forename: Arvinder
authors.initials: A
authors.lastname: Grover
authors.affiliation: Department of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Emily G Y
authors.initials: EG
authors.lastname: Koo
authors.affiliation: Department of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;
authors.forename: Joel A
authors.initials: JA
authors.lastname: Symons
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014664:Vasodilation / Q000502:physiology*; D014739:Victoria / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: complications; endothelium complications; myocardial infarction; noncardiac surgery; renal complications