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, 17 (6), R292

Post-operative Acute Kidney Injury and Five-Year Risk of Death, Myocardial Infarction, and Stroke Among Elective Cardiac Surgical Patients: A Cohort Study

Post-operative Acute Kidney Injury and Five-Year Risk of Death, Myocardial Infarction, and Stroke Among Elective Cardiac Surgical Patients: A Cohort Study

Malene Kærslund Hansen et al. Crit Care.

Abstract

Introduction: The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI.

Methods: We conducted a cohort study among adult elective cardiac surgical patients without severe chronic kidney disease and/or previous heart or renal transplant surgery using data from population-based registries. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria as a 50% increase in serum creatinine from baseline level, acute creatinine rise of ≥26.5 μmol/L (0.3 mg/dL) within 48 hours, and/or initiation of renal replacement therapy within five days after surgery. We followed patients from the fifth post-operative day until myocardial infarction, stroke or death within five years. Five-year risk was computed by the cumulative incidence method and compared with hazards ratios (HR) from a Cox proportional hazards regression model adjusting for propensity score.

Results: A total of 287 (27.9%) of 1,030 patients developed AKI. Five-year risk of death was 26.5% (95% CI: 21.2 to 32.0) among patients with AKI and 12.1% (95% CI: 10.0 to 14.7) among patients without AKI. The corresponding adjusted HR of death was 1.6 (95% CI: 1.1 to 2.2). Five-year risk of myocardial infarction was 5.0% (95% CI: 2.9 to 8.1) among patients with AKI and 3.3% (95% CI: 2.1 to 4.8) among patients without AKI. Five-year risk of stroke was 5.0% (95% CI: 2.8 to 7.9) among patients with AKI and 4.2% (95% CI: 2.9 to 5.8) among patients without AKI. Adjusted HRs were 1.5 (95% CI: 0.7 to 3.2) of myocardial infarction and 0.9 (95% CI: 0.5 to 1.8) of stroke.

Conclusions: AKI, within five days after elective cardiac surgery, was associated with increased five-year mortality and a statistically insignificant increased risk of myocardial infarction. No association was seen with the risk of stroke.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Kaplan Meier curve illustrating the five-year risk of death in the full cohort.
Figure 3
Figure 3
Kaplan Meier curve illustrating the five-year risk of death in the matched cohort.
Figure 4
Figure 4
Causes of death by AKI status.*

Comment in

  • Renal Function After Elective Total Hip Replacement
    H Perregaard et al. Acta Orthop 87 (3), 235-8. PMID 26937782.
    Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical s …

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