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Kidney Week

Abstract: FR-PO035

AKI After Non-Cardiac Surgery as an Independent Predictor of Infection and Malignancy During Long-Term Follow-Up

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tagawa, Miho, Nara Medical University, Kashihara, nara, Japan
  • Nishimoto, Masatoshi, Nara Medical University, Kashihara, nara, Japan
  • Kokubu, Maiko, nara medical university, NARA, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Osaka-Fu, Japan
  • Matsui, Masaru, Nara Prefecture General Medical Center, Nara, NARA, Japan
  • Samejima, Ken-ichi, First Department of Internal Medicine, Nara Medical University, KASHIHARA, Japan
  • Eriguchi, Masahiro, Nara Medical University, Kashihara, nara, Japan
  • Akai, Yasuhiro, Nara Medical University, Kashihara, nara, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, nara, Japan
Background

Previous studies showed that acute kidney injury (AKI) was an independent predictor of all-cause mortality and cardiovascular events. However the associations between AKI and non-cardiac outcomes have not been studied.

Methods

This is a retrospective observational study. Inclusion criteria were adults who underwent non-cardiac surgery under general anesthesia from 2007 to 2011. Exclusion criteria were urologic and obstetric surgeries, subjects missing creatinine values perioperatively, or subjects on dialysis preoperatively. Exposure of interest was AKI within 7 days of surgery by KDIGO criteria. Outcome variables were admission for infection and diagnosis with malignancy (including recurrence). When the outcome was malignancy, subjects who underwent palliative resection of malignancy were excluded. Statistical analyses were performed using Kaplan-Meier curve and Cox regression analyses.

Results

Among 3,939 subjects, there were 289 events of AKI (7.3%). During median follow-up of 4.0 years, there were 291 admissions for infection and 668 were diagnosed with malignancy. Event-free survival among subjects with AKI was significantly lower. After adjustments for potential confounders, AKI was significantly associated with admission for infection and the diagnosis of malignancy (HR 1.73 [1.21-2.47] and 1.50 [1.17-1.92], respectively). Subgroup analyses stratified by age, sex, or history of malignancy yielded similar results. Among subjects with AKI, 11.4 % did not recover renal function during index admission for the surgery. Analyses excluding subjects without recovery of renal function did not change the results.

Conclusion

AKI was an independent predictor of infection and malignancy during long-term follow up after non-cardiac surgery, irrespective of recovery of renal function. There is a possibility that AKI predisposes patients to long-term immunosuppressed state.