title: Preoperative left ventricular dysfunction predisposes to postoperative acute kidney injury and long-term mortality.
abstract: BACKGROUND
  Both preoperative left ventricular dysfunction (LVD) and acute kidney injury (AKI) in the postoperative period are independently associated with mortality. We evaluated the prevalence and prognostic implications of AKI in a cohort of vascular surgery patients.
  
  
  METHODS
  Before vascular surgery, 1,158 patients were screened for LVD. Development of AKI, defined by RIFLE classification, was detected by serial serum creatinine measurements at days 1 to 3 after surgery. Primary end point was cardiovascular mortality during a median follow-up of 2.2 years (interquartile range [IQR] 1.0-4.0).
  
  
  RESULTS
  LVD was present in 558 patients (48%), and 120 patients (10%) developed postoperative AKI. Subjects with LVD developed postoperative AKI more often than patients without LVD (8% vs. 13%, p=0.01). Patients were categorized as (i) no LVD, without AKI (n=551, 48%), (ii) LVD without AKI (n=487, 42%), (iii) no LVD, with AKI (n=49, 4%) and (iv) LVD with AKI (n=71/6%). Patients with LVD prior to surgery who developed postoperative AKI had the highest cardiovascular mortality risk (hazard ratio = 4.9; 95% confidence interval, 2.9-8.2).
  
  
  CONCLUSIONS
  Patients with preoperatively LVD have an increased risk of developing AKI after vascular surgery. The occurrence of AKI in patients with LVD has an incremental predictive value toward cardiovascular mortality risk during long-term follow-up.
authors.affiliation: Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Tabita M
authors.initials: TM
authors.lastname: Valentijn
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.forename: Michiel T
authors.initials: MT
authors.lastname: Voûte
authors.forename: Ruud J
authors.initials: RJ
authors.lastname: Kuiper
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002340:Carotid Artery Diseases / Q000601:surgery*; D015984:Causality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis