Abstract: SA-OR105

Defining Renal Recovery Following Postoperative AKI

Session Information

  • What Happens After AKI
    November 04, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 05:18 PM - 05:30 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Long, Thorir E., Univeristy of Iceland, Reykjavik, Iceland
  • Helgadóttir, Sólveig, Akademiska Hospital Uppsala Univeristy, Uppsala, Sweden
  • Helgason, Dadi, Univeristy of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Gudbjartsson, Tomas, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Gisli H., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Martin I., Duke Univeristy, Durham, North Carolina, United States
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

Consensus on the definition of renal recovery after acute kidney injury (AKI) is lacking. The aim of this study was to examine the association of different definitions of renal recovery with survival among individuals with AKI following surgical procedures.

Methods

This was a retrospective study of all adult patients who underwent abdominal, cardiothoracic, vascular or orthopedic surgery at the University Hospital in Reykjavik in 1998-2015. Clinical data was extracted from electronic medical records. AKI was diagnosed according to the serum creatinine (SCr) part of the KDIGO criteria. Association between 1-year survival and renal recovery of varying degree (SCr reduction to less than 1.5, 1.25 and 1.1 x baseline SCr) and at various time points (10, 20 and 30 days following AKI) was examined by logistic regression. We excluded patients with baseline eGFR <15 mL/min/1.73 m2, those who died during the index admission, and recurrent AKI episodes

Results

A total of 2,410 patients had AKI. All recovery definitions, namely SCr <1.5, 1.25 or 1.10 x baseline SCr at 10, 20 or 30 days after surgery, were significantly associated with 1-year survival. Reaching SCr <1.5 x baseline within 30 days had the strongest relationship with 1-year survival (OR 0.37; 95% CI, 0.29-0.48, p<0.001) in a multivariable logistic model adjusting for age, AKI stage, year of the AKI episode, previous diagnoses of congestive heart failure, chronic pulmonary disease or neoplasm, preoperative eGFR<60 mL/min/1.73 m2 and type of surgery . Increased odds of 1-year mortality was observed for those who had persistent SCr 1.5 x baseline following AKI compared with patients whose SCr returned to <1.1 x baseline (Table).

Conclusion

Among patients with postoperative AKI surviving to hospital discharge, achieving SCr <1.5 x baseline within 30 days had the strongest association with 1-year survival. This might therefore be a useful definition of renal recovery after AKI

Odds ratio for one-year mortality according to renal recovery at 30 days
Recovery at 30 days,
(SCr compared to baseline SCr)
Unadjusted p-valueAdjustedp-value
<1.10 (N=1,430)1.0-1.0-
1.10 – 1.25 (N=218)0.7 (0.4-1.1)0.160.8 (0.5-1.2)0.22
1.25 – 1.50 (N=195)1.3 (0.9-1.9)0.151.2 (0.8-1.8)0.33
> 1.50 (N=567)2.3 (1.8-2.9)<0.0012.5 (1.9-3.2)<0.001

Funding

  • Government Support - Non-U.S.