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Comment & Response
August 2016

Perioperative Acute Kidney Injury—Reply

Author Affiliations
  • 1Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida
  • 2Department of Health Services Research, Management, and Policy, University of Florida, Gainesville
  • 3Department of Anesthesiology, University of Florida, Gainesville
JAMA Surg. 2016;151(8):783. doi:10.1001/jamasurg.2016.0470

In Reply We thank Dr Onuigbo for his comments on our study.1 We agree that identification—and thus prevention—of intraoperative hypotension is a crucial part of the equation in preventing acute kidney injury in surgical patients, especially for patients with known vascular disease. The risk for any postoperative complication, including acute kidney injury, arises from the complex interactions between preoperative status and a patient’s physiologic capacity to withstand the stress of surgery.2 In the preoperative period, a complete accounting of health status and comorbidities can facilitate a discussion with the patient about the risks and benefits of surgery, and can help health care professionals plan for perioperative management to minimize the chance for adverse outcomes. An accurate risk assessment allows physicians to identify patients who would benefit the most from intraoperative strategies that can offset any increased risk. Some of these strategies, such as invasive hemodynamic monitoring, are not only costly but carry their own risks. Others, such as the avoidance of nephrotoxic medications in patients at risk for acute kidney injury, are easy to implement if the risk is identified. And yet both are often applied without consideration of a patient’s preoperative risk or are not applied at all because risk is underestimated.

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