title: Acute Kidney Injury and Long-term Risk of Cardiovascular Events After Cardiac Surgery: A Population-Based Cohort Study.
abstract: OBJECTIVE
  To examine the impact of postoperative acute kidney injury (AKI) on the long-term risk of myocardial infarction, heart failure, stroke, and all-cause mortality after elective cardiac surgery. The authors investigated whether time of onset of AKI altered the association between AKI and the adverse events.
  
  
  METHODS
  Population-based cohort study in 2006-2011.
  
  
  METHODS
  Two university hospitals.
  
  
  METHODS
  Adult elective cardiac surgical patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  AKI was defined as an increase in baseline creatinine according to the Kidney Disease Improving Global Outcomes criteria. AKI was defined within 30 days of surgery, and also analyzed as early- or late-onset AKI. The authors followed patients from postoperative day 30 until hospitalization with myocardial infarction, heart failure, stroke, or death. Adjustment for confounding factors was done using propensity scores and standardized-mortality-ratio weights. A total of 1,457 (30.7%) of 4,742 patients developed AKI within 30 days of surgery and 470 (9.9%) patients experienced a composite cardiovascular endpoint. Comparing patients with and without postoperative AKI, weighted hazard ratio (HR) and 95% confidence intervals (CI) of 5-year risk of the composite cardiovascular endpoint was 1.41 (95% CI: 1.11-1.80). For each endpoint separately the weighted HR was similarly increased. Ninety-one days to 5-year weighted HR of all-cause mortality was 1.37 (95% CI: 1.05-1.80). The effect of AKI was similar for early- and late-onset AKI.
  
  
  CONCLUSIONS
  Early- and late-onset AKI within 30 days of elective cardiac surgery was associated with a similarly increased 5-year risk of myocardial infarction, heart failure, stroke, and increased all-cause mortality.
authors.affiliation: Department of Clinical Epidemiology. Electronic address: mkhansen88@gmail.com.
authors.forename: Malene Kærslund
authors.initials: MK
authors.lastname: Hansen
authors.affiliation: Department of Clinical Epidemiology; Department of Anaesthesiology and Intensive Care.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gammelager
authors.affiliation: Department of Anaesthesiology and Intensive Care.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Jacobsen
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Denmark.
authors.forename: Vibeke Elisabeth
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Clinical Epidemiology; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Layton
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Center for Cardiovascular Research, Aalborg University Hospital, Denmark.
authors.forename: Bodil Steen
authors.initials: BS
authors.lastname: Rasmussen
authors.affiliation: Department of Cardiothoracic Surgery and Clinical Medicine.
authors.forename: Jan Jesper
authors.initials: JJ
authors.lastname: Andreasen
authors.affiliation: Department of Clinical Epidemiology.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Department of Clinical Epidemiology.
authors.forename: Christian Fynbo
authors.initials: CF
authors.lastname: Christiansen
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors
keywords: AKI; cardiac surgery; cardiorenal syndrome; mortality; outcome; stroke