Perioperative Acute Kidney Injury Leading to Chronic Kidney Disease Following Major Abdominal Surgery: A Propensity Score-Matched Analysis

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  • Morita Saori
    Department of Anesthesiology, St. Marianna University School of Medicine
  • Tateda Takeshi
    Department of Anesthesiology, Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine
  • Inoue Souichiro
    Department of Anesthesiology, St. Marianna University School of Medicine

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<p>It is unknown whether acute kidney injury (AKI) affects de novo chronic kidney disease (CKD). The aim of this study was to examine the relationship between de novo CKD and perioperative AKI after major abdominal surgery. We hypothesized that AKI after major abdominal surgery would induce de novo CKD and performed a retrospective observational analysis after adjusting for preoperative covariates with propensity score matching. A total of 347 patients with normal renal function, who underwent major abdominal surgery, were observed for 2 years postoperatively. The incidence of AKI within 7 days of surgery was 13.2%. During the 2-year observation period, de novo CKD occurred in 22% of patients with AKI and in 8% of patients with a non-acute kidney injury (NAKI) (p=0.007). Based on the propensity score-matched analysis, the incidence of CKD was 22% for AKI and 13% for NAKI (p=0.070). All-patient analysis revealed that the probability of being CKD-free was lower in AKI patients, compared to that in NAKI patients (p=0.002). This was not the case for the propensity score-matched analysis (p=0.166). The survival rate was lower in patients with AKI compared to those with NAKI in propensity score-matched analysis (p=0.033).<br/>A Cox proportional hazard regression analysis did not identify any risk factors for de novo CKD after surgery. We found that AKI patients showed higher mortality than non-AKI patients during the 2-year observation period after major abdominal surgery. However, we could not demonstrate that AKI affects de novo CKD in patients without renal dysfunction. The early detection and diagnosis of postoperative AKI will be key to perioperative management for major abdominal surgery.</p>

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