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Clinical Trial
. 2015 Nov;94(45):e2025.
doi: 10.1097/MD.0000000000002025.

Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Jia-Rui Xu  1 , Jia-Ming Zhu, Jun Jiang, Xiao-Qiang Ding, Yi Fang, Bo Shen, Zhong-Hua Liu, Jian-Zhou Zou, Lan Liu, Chun-Sheng Wang, Claudio Ronco, Hong Liu, Jie Teng
Affiliations
Clinical Trial

Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Jia-Rui Xu et al. Medicine (Baltimore). 2015 Nov.

Erratum in

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier cumulative survival rates of (A) AKI and non-AKI patients, (B) non-AKI patients and AKI stage 1, 2, and 3 patients, and (C) non-AKI patients and AKI patients, with complete as well as incomplete renal function recovery. AKI = acute kidney injury.
FIGURE 2
FIGURE 2
Incidence of cumulative chronic kidney disease (stages 4 and 5) after 2 years in AKI and non-AKI patients. AKI = acute kidney injury.
See this image and copyright information in PMC

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