Acute kidney injury after non-cardiovascular surgery: risk factors and impact on development of chronic kidney disease and long-term mortality

Abstract

Objective: To identify factors associated with acute kidney injury (AKI) and its progression to chronic kidney disease (CKD) in a non-cardiac/non-vascular surgery setting.

Methods: This study examined the Veterans Affairs Surgical Quality database for surgical entries between 2000–2014. Demographics, comorbidities, laboratory findings and hospital outcomes were assessed. The primary end-point was the occurrence of AKI, defined as an increase of ≥0.3 mg/dL, 48 h post-operatively. Major adverse cardiac event (MACE) was defined as the composite first occurrence of myocardial infarction, cardiac arrest, and death in 30 days (secondary end-point) and was compared between two groups. Rates of progression to CKD in 1 year and long-term survival were examined.

Main outcome measures: Occurrence of AKI 48 h post-operatively.

Results: AKI was documented in 8.5% of patients. Age, diabetes, and chronic obstructive pulmonary disease, chronic kidney disease, platelet count, serum albumin level, and duration of surgery were identified as independent predictors of AKI. In total, 6.4% patients developed MACE, which was more frequent in patients with AKI (p < .001). Age and pre-operative hematocrit <30% were independent predictors of progression to CKD. Pre-operative hematocrit with a cut-off value of 30% was the only modifiable factor to predict the long-term survival.

Conclusion: Development of AKI is associated with increased odds of various post-operative complications and long-term renal insufficiency and mortality.

Keywords:

• Surgery
• acute kidney injury
• chronic kidney disease
• creatinine

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Declaration of funding

This manuscript was supported by the Veteran Health Administration Western New York Healthcare System in Buffalo, New York. The opinions expressed herein do not necessarily represent those of the Veterans Administration or the US Government.

Declaration of financial/other interests

The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.