title: Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery.
abstract: The aim of the study was to evaluate risk factors for long-term mortality and progressive chronic kidney disease (CKD) after cardiac surgery in patients with normal preoperative renal function and postoperative acute kidney injury (AKI). From April 2009 to December 2012, we prospectively enrolled 3245 cardiac surgery patients of our hospital. The primary endpoints included survival rates and the secondary endpoint was the incidence of progressive chronic kidney disease (CKD) in a follow-up period of 2 years. Acute kidney injury was staged by KDIGO classification. Progressive CKD was defined as GFR ≤ 30 mL/min/1.73 m or end-stage renal disease (ESRD) (starting renal replacement therapy or renal transplantation).The AKI incidence was 39.9% (n = 1295). The 1 and 2 year overall survival (OS) rates of AKI patients were significantly lower than that for non-AKI patients (85.9% and 82.3% vs 98.1% and 93.7%, P < 0.001), even after complete recovery of renal function during 2 years after intervention (P < 0.001). The 2-year overall survival (OS) rates of patients with AKI stage 1, 2, and 3 were 89.9%, 78.6%, and 61.4% (P < 0.001), respectively. Multivariate Cox regression analysis of factors for 2-year survival rates revealed that besides age (P < 0.001), chronic cardiac failure (P < 0.001), diabetes (P < 0.001), cardiopulmonary bypass time (P < 0.01), and length of intensive care unit (ICU) stay (P = 0.004), AKI was a significant risk factor for reducing 2-year survival rates even after complete recovery of renal function (P < 0.001). The accumulated progressive CKD prevalence was significantly higher in AKI than in non-AKI patients (6.8% vs 0.2%, P < 0.001) in the 2 years after surgery. Even with complete recovery of renal function at discharge, AKI was still a risk factor for accumulated progressive CKD (RR 1.92, 95% CI 1.37-2.69).The 2-year mortality and progressive CKD incidence even after complete recovery of renal function were significantly increased in cardiac surgery patients with postoperative AKI.
authors.affiliation: From the Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University (JX, JZ, XD, YF, BS, ZL, JZ, HL, JT); Kidney and Dialysis Institute of Shanghai (JX, XD, YF, BS, ZL, JZ, JT); Kidney and Blood Purification Laboratory of Shanghai, Shanghai (JZ, XD, YF, JZ, HL, JT); Department of Nephrology, Anhui Provincial Hospital, Hefei (JJ); Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China (LL, CW); and Department of Nephrology, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy (CR).
authors.forename: Jia-Rui
authors.initials: JR
authors.lastname: Xu
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Zhu
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Xiao-Qiang
authors.initials: XQ
authors.lastname: Ding
authors.forename: Yi
authors.initials: Y
authors.lastname: Fang
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Liu
authors.forename: Jian-Zhou
authors.initials: JZ
authors.lastname: Zou
authors.forename: Lan
authors.initials: L
authors.lastname: Liu
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Wang
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.forename: Jie
authors.initials: J
authors.lastname: Teng
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis