Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study

Abstract

IntroductionThe prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI.MethodsWe conducted a cohort study among adult elective cardiac surgical patients without severe chronic kidney disease and/or previous heart or renal transplant surgery using data from population-based registries. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria as a 50% increase in serum creatinine from baseline level, acute creatinine rise of ≥26.5 μmol/L (0.3 mg/dL) within 48 hours, and/or initiation of renal replacement therapy within five days after surgery. We followed patients from the fifth post-operative day until myocardial infarction, stroke or death within five years. Five-year risk was computed by the cumulative incidence method and compared with hazards ratios (HR) from a Cox proportional hazards regression model adjusting for propensity score.ResultsA total of 287 (27.9%) of 1,030 patients developed AKI. Five-year risk of death was 26.5% (95% CI: 21.2 to 32.0) among patients with AKI and 12.1% (95% CI: 10.0 to 14.7) among patients without AKI. The corresponding adjusted HR of death was 1.6 (95% CI: 1.1 to 2.2). Five-year risk of myocardial infarction was 5.0% (95% CI: 2.9 to 8.1) among patients with AKI and 3.3% (95% CI: 2.1 to 4.8) among patients without AKI. Five-year risk of stroke was 5.0% (95% CI: 2.8 to 7.9) among patients with AKI and 4.2% (95% CI: 2.9 to 5.8) among patients without AKI. Adjusted HRs were 1.5 (95% CI: 0.7 to 3.2) of myocardial infarction and 0.9 (95% CI: 0.5 to 1.8) of stroke.ConclusionsAKI, within five days after elective cardiac surgery, was associated with increased five-year mortality and a statistically insignificant increased risk of myocardial infarction. No association was seen with the risk of stroke.

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Long-Term Risk of Progressive Chronic Kidney Disease in Patients with Severe Acute Kidney Injury Requiring Dialysis after Coronary Artery Bypass Surgery

“…A recent meta-analysis confirmed that patients who required dialysis for AKI post-operatively had greater early mortality [7]. Although some studies have examined long-term mortality and cardiovascular outcomes in survivors of severe AKI after cardiac surgery [6,11,12,13], few have evaluated the long-term renal outcomes and prognostic factors for chronic kidney disease (CKD) [4]. A systematic review of studies published between 2004 and 2014 by Pickering et al [7] using consensus definitions for AKI did not find any studies that reported associations between bypass-associated AKI and CKD.…”

“…Among patients with severe or multi-vessel coronary artery disease, coronary artery bypass graft (CABG) improves survival compared to medical revascularisation [2]. However, acute kidney injury (AKI) is common after cardiac surgery, ranging from 10 to 60% depending on the definition used [3,4,5,6,7,8]. AKI was associated with greater short-term mortality such that up to 40-60% of patients with severe AKI died during the hospitalisation [3,9,10].…”

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…4,5 Post-operative AKI has important implications relating to subsequent mortality, morbidity, and cost. 4,[6][7][8] Endovascular techniques have evolved greatly since their conception and are now widely applied for the correction of atheromatous and non-atheromatous lesions in various vascular beds. Recently, technological evolutions have allowed the treatment of more complex pathologies using such techniques.…”