Impact of Transient and Persistent Acute Kidney Injury on Chronic Kidney Disease Progression and Mortality after Gastric Surgery for Gastric Cancer

Abstract

Acute kidney injury (AKI) is common after gastric surgery for gastric cancer and associated with adverse outcomes. However, the impact of transient or persistent AKI on clinical outcomes after gastric surgery for gastric cancer has not been described. We performed a retrospective study of 4,886 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2012. AKI patients were classified as transient and persistent AKI based on the return of serum creatinine to the level indicating no AKI within 7 days. Our outcomes included occurrence of new-onset chronic kidney disease (CKD) and mortality 1 year after gastric surgery. AKI occurred in 638 (13.1%) after gastric surgery. Transient AKI was documented in 574 (90%). Use of diuretics and contrast agents was a common risk factor for persistent and transient AKI. Length of intensive care unit (ICU) and hospital stay, and ICU admission rate were higher in patients with transient AKI than in those without AKI. Although patients with persistent AKI had a higher new-onset CKD 1 year after gastric surgery after adjusting for multiple covariates, transient AKI was not associated with new-onset CKD. The 1-year mortality rates were significantly higher in patients with transient and persistent AKI. Not only persistent AKI but transient AKI is associated with increased risk of hospital complications and a significantly higher risk of long-term mortality than patients without AKI after gastric surgery. Moreover, persistent AKI, but not transient AKI, is associated with CKD progression at 1 year.

Transient and Persistent AKI and Outcomes in Patients Undergoing Major Abdominal Surgery

“…Furthermore, there is also an association between AKI duration and long-term outcomes [26]. In a recent metaanalysis of 18 studies by Mehta et al [27], there was an association between longer duration of AKI and longterm outcomes, namely, mortality, cardiovascular outcomes, and progression to CKD.…”

Persistent acute kidney injury following transcatheter aortic valve replacement

“…Recent studies have brought attention to the duration of AKI as an important component affecting clinical outcomes. pAKI is associated with even more severe patient outcomes when compared with transient AKI or no AKI, such as development of progressive chronic kidney disease, increased in‐hospital mortality, and reduced long‐term survival . Perinel and colleagues reported that pAKI developed in 39% of ICU patients (175 of 447) and that it was associated with a higher in‐hospital mortality (38.9%) compared with transient AKI (29.6%) and no AKI (23.8%).…”

“…Perinel and colleagues reported that pAKI developed in 39% of ICU patients (175 of 447) and that it was associated with a higher in‐hospital mortality (38.9%) compared with transient AKI (29.6%) and no AKI (23.8%). In patients undergoing elective gastric surgery, Kim et al reported that only a small percentage of patients (1.3%) had pAKI. However, pAKI led to significant in‐hospital mortality (12.5%) and 1‐year mortality (18.8%).…”

“…Prior studies have shown, however, that AKI duration is another component independently associated with patient outcomes . Worse long‐term outcomes, including end‐stage renal disease and significantly reduced survival, occurred in patients with persistent AKI (pAKI) compared with patients without AKI or transient AKI . Although prevention and management of overall AKI after TAVR is crucial, if pAKI were known to also be significantly predictive of worse outcomes specifically after TAVR, this knowledge could allow further targeting of high‐risk pAKI patients for a multidisciplinary approach with treatment modification and closer clinical follow‐up to improve outcomes.…”

AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms

“…In a meta-analysis of 13 cohort studies, Cocaet al showed that AKI patients had significantly higher risks of developing CKD and end stage renal disease (ESRD) and higher mortality as compared to the patients without AKI 11 . More recently, Kim et al reported that persistent AKI (defined as incomplete reduction of serum creatinine at 7 days) after gastric surgery was associated with CKD progression 1 year later 12 . Similarly, the duration of AKI after cardiac surgery was also regarded as a strong independent risk factor for CKD development 13 .…”