Preoperative proteinuria may be a risk factor for postoperative acute kidney injury:a meta-analysis

Ren Fail. 2021 Dec;43(1):958-967. doi: 10.1080/0886022X.2021.1940201.


Objective: To investigate the relationship between preoperative proteinuria and postoperative acute kidney injury (AKI).

Methods: We performed a search on databases included PubMed, Embase, the Cochrane Library, and Web of Science, from December 2009 to September 2020. Data extracted from eligible studies were synthesized to calculate the odds ratio (OR) and 95% confidence interval (CI). A fixed or random effects model was applied to calculate the pooled OR based on heterogeneity through the included studies.

Results: This meta-analysis of 11 observational studies included 203,987 participants, of whom 21,621 patients suffered from postoperative AKI and 182,366 patients did not suffer from postoperative AKI. The combined results demonstrated that preoperative proteinuria is an independent risk factor for postoperative AKI (adjusted OR = 1.65, 95%CI:1.44-1.89, p < 0.001). Subgroup analysis showed that both preoperative mild proteinuria (adjusted OR = 1.30, 95%CI:1.24-1.36, p < 0.001) and preoperative heavy proteinuria (adjusted OR = 1.93, 95%CI:1.65-2.27, p < 0.001) were independent risk factors for postoperative AKI. The heterogeneity was combined because its values were lower. Further subgroup analysis found that preoperative proteinuria measured using dipstick was an independent risk factor for postoperative AKI (adjusted OR = 1.48, 95%CI:1.37-1.60, p < 0.001). Finally, preoperative proteinuria was an independent risk factor for postoperative AKI in the non-cardiac surgery group (adjusted OR = 2.06, 95%CI:1.31-3.24, p = 0.002) and cardiac surgery group (adjusted OR = 1.69, 95%CI:1.39-2.06, p < 0.001).

Conclusion: Preoperative proteinuria is an independent risk factor for postoperative AKI and in instances when proteinuria is detected using dipsticks.

Keywords: Acute kidney injury; meta-analysis; proteinuria; surgery.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Humans
  • Observational Studies as Topic
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Postoperative Period
  • Proteinuria / complications*
  • Proteinuria / epidemiology
  • Proteinuria / physiopathology
  • Risk Assessment
  • Risk Factors
  • Surgical Procedures, Operative / adverse effects*