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Long-Term Outcomes of Acute Kidney Injury After Different Types of Cardiac Surgeries: A Population-Based Study
Jia-Jin Chen1, Chih-Hsiang Chang1,2, Victor Chien-Chia Wu3
1Department of Nephrology Chang Gung Memorial Hospital, Linkou Medical center Taoyuan Taiwan.
Insights
Dialysis-requiring acute kidney injury (D-AKI) after heart surgery significantly worsens outcomes. Aortic surgery patients had higher D-AKI risk but better recovery and lower long-term dialysis rates compared to other cardiac surgeries.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Public Health
Background:
- Dialysis-requiring acute kidney injury (D-AKI) is a serious complication following cardiovascular surgery, impacting patient prognosis.
- The specific incidence and consequences of D-AKI across diverse cardiac surgical procedures remain incompletely understood.
Purpose of the Study:
- To investigate the incidence and long-term impacts of D-AKI in patients undergoing various types of cardiovascular surgery.
- To compare outcomes, including mortality and major adverse kidney events, between D-AKI and non-D-AKI groups.
Main Methods:
- Retrospective cohort study using Taiwan's National Health Insurance Research Database (2004-2013).
- Patients were categorized into D-AKI (n=3089) and non-D-AKI (n=42,151) groups.
- Outcomes analyzed included all-cause mortality and major adverse kidney events.
Main Results:
- D-AKI patients faced significantly worse long-term outcomes, including higher rates of major adverse kidney events (HR 3.89) and all-cause mortality (HR 2.89).
- Aortic surgery patients had a higher risk of D-AKI but demonstrated better renal recovery and lower long-term dialysis rates post-D-AKI.
- Heart valve surgery patients with D-AKI exhibited the highest risk of all-cause mortality (HR 6.04).
Conclusions:
- Aortic surgery is associated with a higher incidence of D-AKI but offers better renal recovery and improved short-term and long-term outcomes compared to other cardiac surgeries.
- Patients undergoing heart valve surgery with D-AKI face the greatest mortality risk.
- Understanding D-AKI variations by surgical type is crucial for risk stratification and management strategies.
Abstract:
Background Dialysis-requiring acute kidney injury (D-AKI) is a major complication of cardiovascular surgery that results in worse prognosis. However, the incidence and impacts of D-AKI in different types of cardiac surgeries have not been fully investigated. Methods and Results Patients admitted for cardiovascular surgery between July 1, 2004, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The patients were grouped into D-AKI (n=3089) and non-D-AKI (n=42 151) groups. The outcome was all-cause mortality and major adverse kidney event. The long-term outcomes were worse in the D-AKI group than the non-D-AKI group (hazard ratio [HR], 3.89; 95% CI, 3.79-3.99 for major adverse kidney event; HR, 2.89; 95% CI, 2.81-2.98 for all-cause mortality). Patients who underwent aortic surgery had higher risk for D-AKI than other types of surgeries, but they were also more likely to recover. The long-term dialysis rate for the patients who recovered from D-AKI was also lowest in those who underwent aortic surgery. Among all types of cardiac surgeries with D-AKI, patients who had heart valve surgery exhibited the greatest risks of all-cause mortality (HR, 6.04; 95% CI, 5.78-6.32). Conclusions Compared with other heart surgeries, aortic surgery resulted in a higher incidence of D-AKI but better renal recovery, better short-term outcome, and lower incidences of long-term dialysis.
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