Abstract: FR-PO053

Renal Recovery and Progression of CKD Following Postoperative AKI

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

  • Long, Thorir E., University of Iceland, Reykjavik, Iceland
  • Helgadóttir, Sólveig, Akademiska Hospital Uppsala University, Uppsala, Sweden
  • Helgason, Dadi, University 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 University Medical Center, Durham, North Carolina, United States
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

Acute kidney injury (AKI) is a known risk factor for chronic kidney disease (CKD). The aim of this study was to examine how renal recovery associates with the development or progression of CKD among individuals with AKI following surgical procedures.

Methods

This was a retrospective study of all adult patients undergoing abdominal, cardiothoracic, vascular or orthopedic surgery at the University Hospital in Reykjavik in 1998-2015. AKI was defined according to the KDIGO serum creatinine (SCr) criteria. CKD was defined as eGFR <60 ml/min/1.73m2 persistent for ≥90 days, and development and progression of CKD as increase to a higher stage, present for ≥90 days. Association between incident CKD or CKD progression and renal recovery of varying degree (SCr reduction to <1.5, <1.25 and <1.1 x baseline SCr) at 30 days following AKI was compared with a non-AKI control group using propensity score matching (1:1).

Results

Following a total of 43,876 surgeries, 2,497 (5.7%) patients developed AKI. In the AKI group, 1,071 (42.9%) had baseline eGFR <60 ml/min/1.73 m2, compared with 8,562 (20.7%) among those who did not develop AKI. Median follow-up time was 4.4 (range 0.1-18.1) years and 36,563 (83%) patients had two or more SCr measurements available at least 90 days apart. Development or progression of CKD was observed during follow-up in 585 (23.4%) patients with AKI compared with 3.181 (7.7%) of those without AKI (<0.001). Progression of CKD was observed in 19.8%, 25.1%, 36.2% and 27.8% of individuals with renal recovery to <1.10, <1.10-1.25, <1.25-1.5 x baseline SCr and no recovery (SCr >1.5 x baseline SCr) at 30-days, respectively. In comparison, 11% of a propensity score-matched control group without AKI experienced CKD progression during follow-up (p<0.001).

Conclusion

Postoperative AKI increases the risk of development of incident CKD and/or progression of existing CKD, even in patients who experience apparent good renal recovery.

Funding

  • Government Support - Non-U.S.