Abstract: FR-PO064
Postoperative AKI in Noncardiac Surgery and Long-Term Renal Outcome
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tagawa, Miho, Nara Medical University, Nara, Japan
- Nishimoto, Masatoshi, Nara Medical University, Nara, Japan
- Kokubu, Maiko, Nara Prefecture General Medical Center, Nara, NARA, Japan
- Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
- Matsui, Masaru, Nara Prefecture General Medical Center, Nara, NARA, Japan
- Eriguchi, Masahiro, Nara Medical University, Nara, Japan
- Samejima, Ken-ichi, First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
- Akai, Yasuhiro, Nara Medical University, Nara, Japan
- Tsuruya, Kazuhiko, Nara Medical University, Nara, Japan
Background
It is well known that acute kidney injury (AKI) is an independent predictor of long-term renal dysfunction. As a result, the KDIGO guideline recommended evaluation of renal function 3 months after AKI. However, there has been no data to support the recommendation.
Methods
This is a retrospective cohort study on adult patients who underwent non-cardiac surgery under general anesthesia from 2007 to 2011 at Nara Medical University. Exclusion criteria were pre-operative dialysis, urologic, obstetric surgery, or missing creatinine levels pre- and post-operatively. Postoperative AKI (within 1 week from surgery) was determined by the KDIGO criteria. Association between AKI and renal outcome (development of end-stage renal disease or doubling of creatinine) was analyzed using Cox regression and time course of renal function between those with and without AKI was compared by a mixed effects model.
Results
Among 6,692 patients, 445 developed AKI. During a median follow-up of 1.4 years, 493 renal outcomes were observed. Postoperative AKI was an independent predictor of the renal outcome (adjusted HR 3.18 [2.38-4.25]). Decline of estimated glomerular filtration rate (eGFR) was faster among those with AKI (p=0.001). The eGFR decline started at 6 months postoperatively. Even when analysis was limited to those with eGFR≥60 at baseline and 3 months, AKI was significantly associated with development of incident chronic kidney disease (eGFR<60) (HR 1.81 [1.09-3.03]).
Conclusion
AKI after non-cardiac surgery was an independent predictor of renal outcomes. Decline in renal function was more prominent more than 6 months after AKI. Those with preserved renal function at 3 months after AKI have higher risk of progressive renal dysfunction compared with those without AKI. Longer follow-up than KDIGO recommendation is necessary.