Impact of Large Ventral Hernia Repair on Postoperative Renal Function

Large hernia repairs, particularly those involving abdominal wall reconstruction (AWR), can elevate intra-abdominal pressure due to the reintegration of herniated contents into the abdominal cavity, potentially contributing to renal injury. Despite the theoretical risk, the long-term impact of AWR-induced intra-abdominal pressure elevation on renal function remains insufficiently studied. This study aims to evaluate the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) after AWR and to identify key factors associated with postoperative renal impairment.

Adult patients undergoing elective open AWR with transversus abdominis release between January 2014 and March 2022 were included. Patients were stratified by baseline renal function to evaluate the incidence of postoperative AKI, long-term CKD, and CKD progression. Multivariable logistic regression identified predictors of renal impairment.

AKI occurred in 14.2% of patients, with a significantly higher incidence among those with preexisting CKD compared with patients with normal baseline renal function (26.6% vs 11.8%; p < 0.001). At 1-year follow-up, 6.9% of patients with normal baseline renal function developed new-onset CKD, whereas 19.6% of patients with preexisting CKD experienced disease progression (p < 0.001). Dialysis was required in 1.03% of the total cohort, almost exclusively among patients with advanced preoperative CKD (p < 0.001). Postoperative AKI emerged as an independent predictor of CKD progression, with an adjusted odds ratio of 7.51 (95% CI 3.83 to 14.72; p < 0.001).

Patients with preexisting CKD undergoing AWR for large hernias are at elevated risk for postoperative AKI and long-term renal deterioration. Given these findings, perioperative risk stratification and vigilant postoperative renal monitoring are essential. Prevention and early management of AKI should be prioritized to mitigate long-term renal complications in this high-risk population.