Postoperative Acute Kidney Injury : Focus on Renal Recovery Definitions, Kidney Disease Progression and Survival
(2019) In American Journal of Nephrology 49(3). p.175-185- Abstract
BACKGROUND: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD).
METHODS: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1-1.25 × baseline, (iii) 1.25-1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD... (More)
BACKGROUND: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD).
METHODS: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1-1.25 × baseline, (iii) 1.25-1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups.
RESULTS: In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 × baseline (hazard ratio [HR] 1.50; 95% CI 1.29-1.75) and if renal recovery was limited to a fall in SCr to 1.25-1.5 × baseline (HR 1.32; 95% CI 1.12-1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 × baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 × baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001).
CONCLUSIONS: These findings should be considered when a consensus definition of renal recovery after AKI is established.
(Less)
- author
- Long, Thorir E LU ; Helgadottir, Solveig ; Helgason, Dadi LU ; Sigurdsson, Gisli H ; Gudbjartsson, Tomas ; Palsson, Runolfur ; Indridason, Olafur S and Sigurdsson, Martin I
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- keywords
- Acute Kidney Injury/blood, Aged, Aged, 80 and over, Creatinine/blood, Disease Progression, Female, Follow-Up Studies, Glomerular Filtration Rate/physiology, Humans, Iceland/epidemiology, Kidney/physiopathology, Male, Postoperative Complications/blood, Propensity Score, Proportional Hazards Models, Recovery of Function, Renal Insufficiency, Chronic/epidemiology, Retrospective Studies, Risk Factors, Surgical Procedures, Operative/adverse effects, Survival Analysis, Time Factors
- in
- American Journal of Nephrology
- volume
- 49
- issue
- 3
- pages
- 11 pages
- publisher
- Karger
- external identifiers
-
- pmid:30699414
- scopus:85060991145
- ISSN
- 1421-9670
- DOI
- 10.1159/000496611
- language
- English
- LU publication?
- no
- additional info
- © 2019 S. Karger AG, Basel.
- id
- 350158b4-b23a-4169-8e0b-e5f8b219fea4
- date added to LUP
- 2024-12-05 16:12:05
- date last changed
- 2025-04-11 20:16:59
@article{350158b4-b23a-4169-8e0b-e5f8b219fea4,
abstract = {{<p>BACKGROUND: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD).</p><p>METHODS: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1-1.25 × baseline, (iii) 1.25-1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups.</p><p>RESULTS: In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 × baseline (hazard ratio [HR] 1.50; 95% CI 1.29-1.75) and if renal recovery was limited to a fall in SCr to 1.25-1.5 × baseline (HR 1.32; 95% CI 1.12-1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 × baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 × baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001).</p><p>CONCLUSIONS: These findings should be considered when a consensus definition of renal recovery after AKI is established.</p>}},
author = {{Long, Thorir E and Helgadottir, Solveig and Helgason, Dadi and Sigurdsson, Gisli H and Gudbjartsson, Tomas and Palsson, Runolfur and Indridason, Olafur S and Sigurdsson, Martin I}},
issn = {{1421-9670}},
keywords = {{Acute Kidney Injury/blood; Aged; Aged, 80 and over; Creatinine/blood; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate/physiology; Humans; Iceland/epidemiology; Kidney/physiopathology; Male; Postoperative Complications/blood; Propensity Score; Proportional Hazards Models; Recovery of Function; Renal Insufficiency, Chronic/epidemiology; Retrospective Studies; Risk Factors; Surgical Procedures, Operative/adverse effects; Survival Analysis; Time Factors}},
language = {{eng}},
number = {{3}},
pages = {{175--185}},
publisher = {{Karger}},
series = {{American Journal of Nephrology}},
title = {{Postoperative Acute Kidney Injury : Focus on Renal Recovery Definitions, Kidney Disease Progression and Survival}},
url = {{http://dx.doi.org/10.1159/000496611}},
doi = {{10.1159/000496611}},
volume = {{49}},
year = {{2019}},
}