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Kidney Week

Abstract: PO2104

Cardiovascular Events and Mortality in Adults with Kidney Failure after Major Noncardiac Surgery

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Harrison, Tyrone, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Wick, James, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ruzycki, Shannon M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Mccaughey, Deirdre, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Zarnke, Kelly B., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
Background

People with kidney failure have a high incidence of major surgery. Despite this surgical exposure, there is a paucity of literature investigating postoperative CV events and death. We aimed to determine the risk of these outcomes based on surgery type.

Methods

This retrospective cohort study used administrative health data from Alberta, Canada from April 2005 to February 2017. Adults (≥18 years) with kidney failure (receipt of chronic dialysis or two outpatient eGFR measures <15 mL/min/1.73m2) admitted to hospital for a surgical procedure were included. Surgery type, categorized using ICD-10 codes from hospitalization data, was examined for association with acute myocardial infarction (AMI) and death within 30 days of surgery using multivariable logistic regression. We adjusted for demographics, comorbidities, preoperative laboratory measures, procedure urgency, and kidney disease specific variables.

Results

3398 people with kidney failure had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Most of the cohort was male (61.0%), the median age was 61.5 years (IQR 50.0, 72.7), and over half of the procedures were urgent (56.9%). 198 people (5.8%) had an AMI or died within 30 days of major surgery. Kidney transplantation had the lowest frequency of the outcome and were the reference group. After adjustment, vascular, skin and soft tissue, intraabdominal, musculoskeletal, retroperitoneal, anorectal, and neurosurgical procedures had statistically higher odds of AMI or death compared to kidney transplantation (Figure 1).

Conclusion

Major non-transplant surgery in people with kidney failure is associated with a high risk of AMI and death, which has implications for the direction of future perioperative research in this population.

Odds of AMI and Death for people with kidney failure undergoing major non-cardiac surgery stratified by surgery type.

Funding

  • Government Support - Non-U.S.