Incidence and Associations of Acute Kidney Injury After Lung Resection Surgery: A Systematic Review and Meta-analysis

The incidence and clinical implications of acute kidney injury (AKI) following thoracic lung resection surgery remain insufficiently characterized. The authors conducted a systematic review to determine the incidence of AKI, identify risk factors for AKI, evaluate preventive interventions for AKI, and assess the associations of AKI with key postoperative outcomes. A systematic search of PubMed, Embase, and the Cochrane Library was conducted through June 25, 2025. The authors included observational and interventional studies that reported the incidence of AKI following lung resection, defined according to Risk, Injury, Failure, Loss, End-stage (RIFLE), Acute Kidney Injury Network (AKIN), or Kidney Disease: Improving Global Outcomes (KDIGO) consensus-based criteria. The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251142075). Twenty studies involving 19,918 patients were included. The pooled incidence of AKI was 5.31% (95% confidence interval [CI], 3.61%-6.70%), with mild AKI and moderate to severe AKI occurring in 5.51% and 0.96% of patients, respectively. AKI was significantly associated with prolonged hospital stay (mean difference, 0.92 days; 95% CI, 0.52-1.30 days) and increased short-term mortality (risk ratio, 5.60; 95% CI, 1.66-18.83). Goal-directed fluid therapy did not significantly reduce the risk of AKI (risk ratio, 0.64; 95% CI, 0.32-1.27). AKI is a common complication following thoracic lung resection surgery and is strongly associated with a broad spectrum of severe adverse postoperative outcomes. In patients undergoing lung resection, AKI should be considered as a highly significant prognostic indicator that requires early risk stratification and proactive preventive strategies.