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Acute and Chronic Kidney Disease and Cardiovascular Mortality After Major Surgery

Tezcan Ozrazgat-Baslanti1, Paul Thottakkara, Matthew Huber

  • 1*Department of Anesthesiology, University of Florida, Gainesville, FL†Chief Data Officer, University of Florida Health and Science Center, Gainesville, FL‡Department of Medicine, University of Florida, Gainesville, FL§Department of Surgery, Malcom Randall VA Medical Center, Gainesville, FL¶Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL.

Annals of Surgery
|January 13, 2016
PubMed

Insights

Major surgery patients with acute kidney injury (AKI) or chronic kidney disease (CKD) face significantly higher long-term cardiovascular mortality. Kidney disease is a critical risk factor for post-surgical death.

Area of Science:

  • Nephrology
  • Cardiology
  • Surgery

Background:

  • Pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) post-surgery increase mortality risk in surgical patients.
  • Kidney dysfunction is a significant, often overlooked, predictor of adverse outcomes after major surgical procedures.

Purpose of the Study:

  • To investigate the long-term cardiovascular-specific mortality rates in patients who experienced AKI or CKD following major surgery.
  • To quantify the association between different stages of kidney disease and cardiovascular death after major inpatient surgery.

Main Methods:

  • A single-center cohort study analyzed 51,457 adult surgical patients.
  • Multivariable subdistributional hazards models were used to assess cardiovascular mortality, treating other causes of death as competing risks.
  • The analysis accounted for progression to end-stage renal disease (ESRD) post-discharge, with pre-existing CKD, ESRD, and postoperative AKI as key predictors.

Main Results:

  • 39% of patients developed AKI during hospitalization; 8% had pre-existing CKD.
  • At 10-year follow-up, cardiovascular mortality ranged from 6% (no kidney disease) to 27% (ESRD).
  • Patients with de novo AKI had a 1.95-fold increased hazard ratio for cardiovascular mortality, while pre-existing ESRD patients had a 5.70-fold increased hazard ratio compared to those with no kidney disease.

Conclusions:

  • Both acute kidney injury (AKI) and chronic kidney disease (CKD) are independently associated with elevated long-term cardiovascular-specific mortality after major surgery.
  • Kidney disease status is a crucial determinant of cardiovascular outcomes in the surgical population.
Abstract

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