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Postoperative Acute Kidney Injury: Focus on Renal Recovery Definitions, Kidney Disease Progression and Survival
Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Internal Med Serv, Reykjavik, Iceland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Internal Med Serv, Reykjavik, Iceland.
Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Natl Univ Hosp Iceland, Div Anesthesia & Intens Care Med, Reykjavik, Iceland.
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2019 (English)In: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 49, no 3, p. 175-185Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD).

Methods: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 x baseline, (ii) 1.1-1.25 x baseline, (iii) 1.25-1.5 x baseline, and (iv) > 1.5 x baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups.

Results: In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 x baseline (hazard ratio [HR] 1.50; 95% CI 1.29-1.75) and if renal recovery was limited to a fall in SCr to 1.25-1.5 x baseline (HR 1.32; 95% CI 1.12-1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 x baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 x baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001).

Conclusions: These findings should be considered when a consensus definition of renal recovery after AKI is established.

Place, publisher, year, edition, pages
KARGER , 2019. Vol. 49, no 3, p. 175-185
Keywords [en]
Acute kidney injury, KDIGO criteria, Definition, Serum creatinine, Renal recovery, Chronic kidney disease, Survival
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-381212DOI: 10.1159/000496611ISI: 000462034300001PubMedID: 30699414OAI: oai:DiVA.org:uu-381212DiVA, id: diva2:1303210
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved

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Helgadottir, Solveig

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