Perioperative acute injury to the kidney is associated with the development and progression of chronic kidney disease in the year following noncardiac surgery, a study has concluded.
The team of researchers at Duke University Medical Center did not observe a dose–response relationship between acute kidney injury (AKI) severity and subsequent risk for chronic kidney disease.
“The association between postoperative acute kidney injury and the progression of chronic kidney disease has been shown in the cardiac surgery literature,” said Mohammad R. Rasouli, MD, a clinical fellow in anesthesia critical care at Duke, in Durham, N.C. “Nevertheless, there is a lack of data in the noncardiac surgery population.
As part of the study, serum creatinine levels were used to identify AKI stage within seven days of surgery, using criteria from the Kidney Disease: Improving Global Outcome (KDIGO) guidelines (Table). The primary outcome was one-year progression of chronic kidney disease of at least one stage in patients with preexisting chronic kidney disease. The development of new chronic kidney disease in patients without preexisting kidney disease also was examined.
Perioperative AKI Linked to Chronic Disease
The study involved 69,419 cases that met inclusion criteria, of whom 1,696 developed perioperative AKI (2.4%). Of those patients, 1,358 were AKI class 1 (80%), 197 were AKI class 2 (12%), and 141 (8%) were AKI class 3 (8%).
Moreover, the study showed that 342 of 1,023 patients (33.4%) who did not have preexisting chronic kidney disease developed the condition within a year of AKI.
Similarly, 269 of 673 patients (39.9%) with preexisting chronic kidney disease saw their disease worsen within a year of AKI development.
The study showed that even through someone might expect that if there’s more severe AKI then you are more likely to have chronic kidney disease progression however this study didn’t reveal that fact.
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