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. 2010 Nov;78(9):926-33.
doi: 10.1038/ki.2010.259. Epub 2010 Aug 4.

The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans

Steven G Coca  1 , Joseph T King Jr, Ronnie A Rosenthal, Melissa F Perkal, Chirag R Parikh
Affiliations

The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans

Steven G Coca et al. Kidney Int. 2010 Nov.

Abstract

Acute kidney injury (AKI) is primarily defined and staged according to the magnitude of the rise in serum creatinine. Here we sought to determine if the duration of AKI adds additional prognostic information above that from the magnitude of injury alone. We prospectively studied 35,302 diabetic patients from 123 Veterans Affairs Medical Centers undergoing their first noncardiac surgery. The main outcome was long-term mortality in those who survived the index hospitalization. AKI was stratified by magnitude according to AKI Network stages and by the duration (short (less than 2 days), medium (3-6 days) or long (7 days or more)). Overall, 17.8% of patients experienced at least stage 1 AKI or greater following surgery. Both the magnitude and duration of AKI were significantly associated with long-term survival in a dose-dependent manner. Within each stage, longer duration of AKI was significantly associated with a graded higher rate of mortality. However, within each of the duration categories, the stage was not associated with mortality. When considered separately in multivariate analyses, both a higher stage and duration were independently associated with increased risk of long-term mortality. Hence, the duration of AKI adds additional information to predict long-term mortality.

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Figures

Figure 1
Figure 1. Kaplan Meier Survival Plots of AKI by Magnitude and Duration
Panel A. Survival among patients by AKIN stages of AKI versus no AKI. Increasing AKIN stage is associated with worse survival. Panel B. Survival among patients by duration of AKI versus no AKI. Increasing duration of AKI is associated with worse survival.
Figure 2
Figure 2. Mortality Rates by Magnitude and Duration of AKI
No increase in mortality rate is seen by AKIN Stage within AKI as stratified by duration. However, the mortality rate increased by duration within AKI as stratified by AKIN stage. The mortality rate for those with AKIN Stage 1 and long duration of AKI is more than 2-fold higher than for those with AKIN Stage 3 and short duration of AKI.
Figure 3
Figure 3. Kaplan Meier Survival Plots: AKIN Stages Stratified by Duration
Survival among patients by short, medium and long duration of AKI within AKIN stages 1, 2 and 3 (panels A, B, and C, respectively). Patients with increasing duration of AKI had significantly worse survival in every stage of AKIN.
Figure 4
Figure 4. Kaplan Meier Survival Plots: AKI Duration stratified by AKIN Stages
Survival among patients by AKIN stages 1, 2 and 3 within short, medium, and long duration of AKI (panels A, B, and C, respectively). Once stratified by duration of AKI, there is minimal additional prognostic information offered by magnitude of creatinine rise.
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