Abstract: FR-PO081

Preoperative Renin-Angiotensin System Inhibitors Increased AKI after Noncardiac Major Surgery

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Cho, Hyunjeong, Seoul National University Hospital, Jongno- gu, SEOUL, Korea (the Republic of)
  • Park, Seokwoo, Seoul National University Hospital, Jongno- gu, SEOUL, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, GYEONGGI-DO, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Jongno- gu, SEOUL, Korea (the Republic of)
  • Oh, Kook-Hwan, Seoul National University Hospital, Jongno- gu, SEOUL, Korea (the Republic of)
  • Joo, Kwon Wook, Seoul National University Hospital, Jongno- gu, SEOUL, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
Background

Many conflicting results have been reported on the association between preoperative renin-angiotensin system (RAS) inhibitors and postoperative acute kidney injury (AKI). In this study, we evaluated the impact of RAS inhibitors on postoperative AKI and mortality after noncardiac major surgery.

Methods

We analyzed a retrospective cohort of 50,897 adult patients (age≥18) underwent noncardiac major surgery from 2004 to 2013. Major surgery was defined as surgery duration more than 1 hour. Patients with chronic kidney disease (CKD) 5, nephrectomy and kidney transplantation were excluded. The primary outcome was postoperative AKI defined by the KDIGO creatinine criteria and initiation of dialysis within 14 days of surgery. The secondary outcomes were all-cause mortality within 30 days of surgery and length of hospital stay. Propensity scores matching and multivariable logistic regression analyses were performed.

Results

The patient mean age was 54.3 years, 44.5% were males. In overall, 2,686 (5.3%) patients developed AKI events after operation. RAS inhibitors were used in 1,486 patients. After propensity score matching, 2,955 patients were divided into two groups: using (n=1,469) or not using (n=1,486) preoperative RAS inhibitors. There were no differences in baseline parameters, including age, sex, body mass index, CKD stage, history of diabetes and the American Society of Anesthesiologists physical status. Preoperative RAS inhibitor use was associated with 50% higher risk of postoperative AKI (adjusted relative risk (RR): 1.501; 95% confidence interval (CI): 1.103-2.044; P = 0.01) after adjusting for potential confounders. In addition, RAS inhibitor use was related to prolonged hospitalization (P = 0.000). The 30-day mortality rate was 0.6%, with no significant difference between RAS inhibitor use and non-use (P = 0.149).

Conclusion

This large cohort study demonstrates that preoperative RAS inhibitors were associated with a higher risk of AKI, but not mortality. Withholding preoperative RAS inhibitors should be considered in the perioperative setting.