Postoperative Acute Kidney Injury Is Associated With Progression of Chronic Kidney Disease Independent of Severity

• Published in: Anesthesia & Analgesia
• Main Authors: Privratsky, Jamie R., Krishnamoorthy, Vijay, Raghunathan, Karthik, Ohnuma, Tetsu, Rasouli, Mohammad R., Long, Thorir E., Sigurdsson, Martin I.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Ovid Technologies (Wolters Kluwer Health) 2021
• Subjects: Iceland
• Online Access: http://dx.doi.org/10.1213/ane.0000000000005702; https://journals.lww.com/10.1213/ANE.0000000000005702

BACKGROUND: Both postoperative acute kidney injury (AKI) and preoperative chronic kidney disease (CKD) are associated with significantly worse outcomes following surgery. The relationship of both of these conditions with each other and with CKD progression after surgery remains poorly studied. Our objective was to assess if there was an interaction between preoperative kidney function estimated by preoperative estimated glomerular filtration rate (eGFR)/CKD stage, postoperative AKI, and eGFR/CKD progression within 1 year of surgery. Our hypothesis was that AKI severity would be associated with a faster time to eGFR/CKD stage progression within 1 year of surgery in a graded-fashion, which would be exacerbated by preoperative kidney dysfunction. METHODS: This was a retrospective cohort study at Landspitali University Hospital in Iceland, which serves about 75% of the population. Participants included adults receiving their first major anesthetic between 2005 and 2018. Patients with CKD stage 5, undergoing major urologic procedures, or having missing creatinine values for follow-up of eGFR stage were excluded from analysis. The primary exposure was postoperative AKI stage within 7 days after surgery classified by the kidney disease improving global outcome (KDIGO) criteria. The primary outcome was time to progression of CKD by at least 1 eGFR/CKD stage within 1-year following surgery. Multivariable Cox proportional hazards models were used to estimate hazard of eGFR/CKD stage progression, including an interaction between AKI and preoperative CKD on eGFR/CKD stage progression. RESULTS: A total of 5548 patients were studied. In the multivariable model adjusting for baseline eGFR/CKD stage, when compared to patients without AKI, postoperative AKI stage 1 (hazard ratio [HR], 5.91; 95% confidence interval [CI], 4.34–8.05), stage 2 (HR, 3.86; 95% CI, 1.82–8.16), and stage 3 (HR, 3.61; 95% CI, 1.49–8.74) were all independently associated with faster time to eGFR/CKD stage progression within 1 year following surgery, ...