Daniela Bandić Pavlović

Consequence of Elevated Fibroblast Growth Factor 23 Levels in Acute Kidney Injury, Renal Recovery and Overall Survival in Intensive Care Unit Patients After Major Surgery: FGF23 and Acute Kidney Injury

The main goal of our study was to investigate the role of increased fibroblast growth factor 23 (FGF23) levels on renal recovery and overall survival. We conducted a prospective case‐control cohort study, which included 121 adult cases who developed AKI after major surgical procedures. The subjects were followed‐up until the last enrolled patient survived 180 days or until the time of death. Higher FGF23 levels positively correlated with serum creatinine levels (P < 0.05). Significantly higher number of patients without diuresis and with FGF23 ≤ 709 RU/mL survived when compared to patients without diuresis and with FGF23 ≥ 709 RU/mL (P < 0.001). FGF23 levels >709 RU/mL were a good predictive tool for overall mortality in a 6‐month period (P < 0.05). This is the first study to analyze the impact of FGF23 values on short‐term renal recovery and survival of patients with AKI after major surgery. The FGF23 increase related to AKI especially in more severe stages and in patients without diuresis is an independent risk factor for mortality.

Učinak inhalacijskih anestetika na akutno oštećenje bubrega

Acute kidney injury (AKI) is a serious complication associated with increased morbidity and mortality. Total incidence of AKI in hospitalized patients is 1%-5%. As many as 30% of these patients develop AKI in the perioperative period, which is associated with anesthesia and surgery. Despite scientific advances and improved surgery techniques, as well as treatment in intensive care units, no significant decrease in AKI incidence has been achieved. To change this outcome, it is important to identify patients at risk of AKI and prevent its occurrence. Correct selection of anesthetic drugs during general anesthesia, adjusted to the individual needs of patients, also influences the overall outcome of treatment. Nowadays, inhalational anesthetics are not considered nephrotoxic. The more so, inhalational anesthetics have a strong and direct protective effect on many organs through preconditioning and postconditioning. New studies have shown that sevoflurane diminishes ischemia/ reperfusion kidney injury and has an anti-inflammatory effect, thus having the potential to reduce the occurrence of AKI. Given the incidence of AKI in the perioperative period, as well as new findings about anesthetics, the issue of anesthetic selection during general anesthesia might be of crucial importance for the final outcome of treatment.

Inadvertent hypothermia during the perioperative period

Inadvertent hypothermia, which is defined as temperature below 36°C, is common in the perioperative setting. Patients un-der general or regional anaesthesia have impaired temperature regulation/homeo-stasis. Temperature monitoring should be an established standard for all procedures that last more than 30 minutes. Unfortu-nately, study shows that it is not a common practice in European hospitals. Passive and active patient warming should be used to prevent and treat hypothermia. Warming should start in the preoperative period and last throughout all perioperative phases. In that way, well-known complication of hy-pothermia should be prevented. Cardiac event, coagulopathy and wound infection are the leading causes of delayed discharge and more adverse outcomes related to hy-pothermia. It is especially important to un-dertake all necessary intervention proce-dures to prevent hypothermia in a group of patients with known high number of risk factors for hypothermia. Ambient tem-perature, an important risk factor, should be monitored and maintained at about 21°C. According to reviewed evidence, the protocol to prevent, monitor and treat hy-pothermia should be established. Further studies about the implementation of tem-perature monitoring and regulation are needed in order to raise awareness about this issue.