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Abstract: SA-PO134

Smaller Kidney Volume Is Associated with AKI Following Cardiovascular Surgery, Especially Among Patients Treated with Renin-Angiotensin System Inhibitors

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Kasugai, Takahisa, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Murashima, Miho, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Tomonari, Tatsuya, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Ono, Minamo, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Mizuno, Masashi, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Kidney volume might reflect atherosclerotic changes in the vascular bed in the kidney independent of eGFR and thus might be independently associated with postoperative AKI.


In this retrospective cohort study, we enrolled adults who underwent cardiovascular (CV) surgery from 2014 to 2021 at our facility and computed tomography (CT) scans within 6 months before surgery. We excluded those with multiple or large cysts, single kidney, serum creatinine >4 mg/dL, or undergoing kidney replacement therapy. Exposure of interest was height-adjusted total kidney volume (htTKV) measured by software using the three-dimensional CT reconstruction. The outcome was postoperative AKI defined by the KDIGO creatinine criteria. We employed logistic regression models and the results were shown as cubic spline curves. Effect modifications by renin-angiotensin system inhibitors (RASi, defined as angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers), loop diuretics, and non-steroidal anti-inflammatory drugs (NSAIDs) were assessed.


Among 433 patients, 147 (33.9%) developed AKI. Those with smaller htTKV were older, less likely to be diabetic, had lower eGFR, and higher prevalence of CV comorbidities. Smaller htTKV tended to be associated with AKI even after adjustment for eGFR. Smaller htTKV was associated with AKI especially among the users of RASi (p for interaction 0.02). Loop diuretics and NSAIDs did not significantly modify the association between htTKV and AKI(p for interaction 0.44 and 0.42, respectively).


Smaller htTKV was associated with postoperative AKI independent of eGFR, especially among patients using RASi.Among patients with smaller htTKV, withdrawing RASi before CV surgery might be protective against post-operarive AKI.