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Abstract: FR-PO091

Time-Trend of Postoperative AKI From a Multicenter Cohort Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Cho, Jeongmin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kwon, Soie, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
  • Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Jeonghwan, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)
  • Baek, Chung Hee, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
  • Kim, Ji Eun, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  • Hwang, Jin Ho, Chung Ang University Hospital, Seoul, Korea (the Republic of)
  • Park, Ji In, Kangwon National University Hospital, Chuncheon, Kangwon, Korea (the Republic of)
  • Ryu, Jiwon, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Park, Jina, Biomedical Research Institute, 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)
  • Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Background

After emphasis on prevention and early recognition of acute kidney injury (AKI) from the KDIGO 2012 AKI guideline, in-hospital AKI occurrence had reduced during the past two decades. However, understanding the time trend of post-operative AKI (PO-AKI) is lacking yet.

Methods

A retrospective cohort study was performed from 2005 to 2020. The patients who underwent non-cardiac major surgery more than 1 hour of operation time at 5 departments were enrolled. PO-AKI was defined as KDIGO AKI criteria within 7 days after surgery. Severe PO-AKI (S-PO-AKI) was defined as stage 2 or 3 AKI. The time period was divided into 3-year intervals and evaluated by join-point regression analysis and multivariate logistic regression.

Results

A total of 143,219 patients were included. During the study period, 8,604 (6.0%) PO-AKI and 1,197 (0.8%) S-PO-AKI occurred. The patients were older and more women. They had more comorbidities including diabetes mellitus (5.7%→13.7%), hypertension (12.8%→28.6%), coronary artery disease (1.8%→3.6%) as times go by. Preoperative NSAID usage was decreased whereas diuretics and RAAS blockades uses were increased with time. The PO-AKI incidence had decreased from 8.9% in 2014 to 4.6% in 2020. In join-point analysis, PO-AKI incidence decreased with annual percent change (APC) of -4.2 % per year (95% confidence interval [CI] -5.5 – -2.8%, p-value <0.001), Although, S-PO-AKI was not (APC -0.3%, 95% CI -2.1 – 1.5%, p-value = 0.732, Figure 1). The multivariate analysis showed that these trends were remained similarly even after adjustment with well-known risk factors (adjusted odds ratio [95% CI], 2005-2007, reference; 2008-2010, 0.77 [0.71-0.84]; 2011-2013, 0.69 [0.63-0.75]; 2014-2016, 0.55 [0.51-0.59]; and 2018-2020, 0.57 [0.53-0.62]. p-value<0.001).

Conclusion

In this large-scale study, we found the PO-AKI had decreased recently, although the incidence of S-PO-AKI still had not changed.

Figure 1. Join-point regression analysis describing annual incidence trend of (A) PO-AKI and (B) S-PO-AKI.