Mortality and Cost of Acute and Chronic Kidney Disease after Vascular Surgery

Abstract

Introduction Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common yet underappreciated risk factors for adverse perioperative outcomes. We hypothesize that AKI and CKD are associated with similar increases in ninety-day mortality and cost in patients undergoing major vascular surgery. Methods We used multivariable regression analyses to evaluate the associations between acute and chronic kidney disease and incremental ninety-day mortality and hospital cost in a single-center cohort of 3,646 adult patients undergoing major vascular surgery. We defined AKI using KDIGO (Kidney Disease: Improving Global Outcomes) criteria as change in creatinine ≥ 0.3 mg/dl or ≥50% increase from the reference value. CKD was determined from medical history. Regression models were adjusted for demographic and socio-economic characteristics, comorbid conditions, surgery type, and postoperative complications. Results The prevalence of kidney disease among vascular surgery patients is high with 49% of patients developing AKI during hospitalization and 17% presenting with CKD on admission. In risk-adjusted logistic regression analysis, perioperative AKI (OR 2.2, 95% CI 1.5-3.3) was the most significant predictor of ninety-day mortality. The risk-adjusted average cost was significantly higher for patients with any type of kidney disease. The incremental cost of having any type of kidney disease ranged from $9,100 to $19,100, even after adjustment for underlying comorbidities and other postoperative complications. Conclusions Kidney disease after major vascular surgery is associated with significant increase in ninety-day mortality and cost with the highest risk observed among patients with AKI regardless of previous CKD.

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…74 However, smaller changes in sCr are associated with adverse outcomes following CVS. [75][76][77][78] Given the association of stage 1 AKI (sCr 1.5 times baseline or ≥0.3-mg/dL increase within 48 hours) with adverse outcomes in multiple settings, it is important to recognize stage 1 AKI (based on sCr and/or UO criteria) so that the progression to stage 2 (sCr 2.0 times baseline) or stage 3 AKI and other outcomes can be monitored. In addition, sCr criteria alone may miss %30% of patients with AKI, resulting in both misclassification of AKI severity and delay in management.…”

Remote Ischaemic Preconditioning Reduces Kidney Injury Biomarkers in Patients Undergoing Open Surgical Lower Limb Revascularisation: A Randomised Trial

“…In addition to RIPC, anaesthetic dexmedetomidine is also a promising renoprotective agent [20]. However, as most lower limb revascularisation operations are not performed under general Postoperative AKI has been found to occur in 12.7−49% of patients undergoing vascular surgery [1,5]. Patients with coexisting PAD are at greater risk for AKI.…”

“…AKI is associated with worse outcome and especially with higher risk for cardiovascular disease [1,4]. Even small changes in creatinine are associated with higher mortality, morbidity, and a greater economic burden [5].…”

Increased risk of mortality after lower extremity bypass in individuals with acute kidney injury in the Vascular Quality Initiative

“…Postoperative AKI has been reported to complicate as many as 50% of all vascular procedures and is independently associated with a prolonged hospital stay, increased perioperative mortality, and decreased longterm survival. 2,3 Risk for AKI is not uniform, however, across all vascular procedures and may differ according to the anatomic location or whether the procedure is open or endovascular. For example, the need for aortic cross-clamping during aortic surgery and the use of significant intraprocedural contrast during endovascular procedures are major risk factors for AKI that do not apply to LEB.…”