AKI correlates with poor kidney outcomes 3 months after non-cardiac surgery
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Regardless of eGFR, AKI correlated with poor kidney outcomes 3 months following non-cardiac surgery, according to results of a recently published study.
Further, creatinine-based eGFR 3 months after AKI may be impacted by acute illness-induced loss of muscle mass.
“Compared with AKI after cardiac surgery or in the intensive care setting, AKI after non-cardiac surgery has not been extensively investigated, presumably because the incidence of such AKI is lower; however, the annual number of patients who undergo non-cardiac surgery is much larger than the annual number of patients who undergo cardiac surgery or receive critical care,” Masatoshi Nishimoto, MD, PhD, from the department of nephrology at Nara Medical University in Japan, and colleagues wrote. They added, “Thus, we examined long-term kidney outcomes after postoperative AKI in patients who underwent non-cardiac surgery; such patients survive for long periods after AKI and require kidney function preservation.”
In a retrospective cohort study, researchers examined data for 5,272 adults who underwent non-cardiac surgery under general anesthesia between April 2007 and December 2011 at Nara Medical University Hospital. Postoperative AKI within 7 days of surgery served as the exposure in the study.
Using linear mixed-effects models, researchers compared eGFR slopes in patients with and without AKI. Additionally, researchers conducted multivariable Cox proportional hazard models to determine the correlation of AKI with incident CKD and at least a 30% decline in eGFR.
Overall, 6% of patients developed AKI by the end of the study period. Patients with AKI were older, had a higher BMI and had a lower baseline eGFR, compared with those without AKI. A total of 1,194 patients had follow-up creatinine values, and eGFR was stable or increased among patients with and those without AKI at 3 months postoperatively. The eGFR declined after 3 months but declined fastest among patients with AKI.
Of the 939 patients without CKD at baseline and at 3 months postoperatively, 226 and 161 developed incident CKD and a decreasing in eGFR of at least 30%, respectively.
“In conclusion, AKI was associated with worse kidney outcomes regardless of eGFR at 3 months postoperatively,” Nishimoto and colleagues wrote. “The evaluation of creatinine-based eGFR at 3 months after AKI might have limited value because of acute illness-related muscle mass reduction; the use of measured creatinine clearance or cystatin C-based eGFR might provide greater clinical benefit. Finally, the preservation of creatinine-based eGFR at 3 months after AKI does not guarantee subsequent preservation of kidney function.”
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