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Meta-Analysis
. 2025 Dec;57(1):2547324.
doi: 10.1080/07853890.2025.2547324. Epub 2025 Aug 17.

Incidence and risk factors of acute kidney injury after abdominal surgery: a systematic review and meta-analysis

Jian Liu  1   2 , Shi-Hui Lin  1 , Yi-Si Zhao  1 , Ren-Jie Luo  1 , Zheng-Tao Zhang  1 , Liu-Yang Wang  1 , Ke Xie  1 , Jing Fan  1 , Mu Zhang  1 , Yu-Sen Chai  3 , Hong Tang  1 , Fang Xu  1
Affiliations
Meta-Analysis

Incidence and risk factors of acute kidney injury after abdominal surgery: a systematic review and meta-analysis

Jian Liu et al. Ann Med. 2025 Dec.

Abstract

Objective: To determine the incidence of acute kidney injury (AKI) following abdominal surgery, assess its outcome associations, and identify factors associated with postoperative AKI development.

Methods: We performed a systematic search of PubMed, Embase, and Cochrane Database of Systematic Reviews, from January 2004, to December 2024. We included studies reporting AKI based on consensus criteria (RIFLE, AKIN, or KDIGO) in adult abdominal surgery patients.

Results: A total of 162 studies (675361 patients) were included. The pooled AKI incidence was 16% (95% CI: 14-17%), with significant variation by surgical procedure. Meta-analysis showed AKI was significantly associated with increased short-term mortality (risk ratio [RR], 6.46; 95% CI: 4.63-9.00) and long-term mortality (RR, 6.36; 95% CI: 3.32-12.16). Mortality risk demonstrated stage-dependent increase, with RR of 2.74 (95%CI: 1.77-4.24), 8.01 (95%CI: 3.18-20.18), and 15.73 (95%CI: 5.52-44.81) for AKI stages 1, 2, and 3, respectively. AKI was associated with prolonged hospital stay (weighted mean difference 4.72 days; 95%CI: 3.43-6.02), also showeing stage-dependent increase of 5.03, 11.16, and 14.46 days for stages 1, 2, and 3, respectively. Twenty-five risk factors were associated with AKI. Meta-analysis of randomized controlled trials revealed that individualized blood pressure target management significantly reduced AKI incidence (RR, 0.67; 95% CI: 0.52-0.88).

Conclusions: AKI remains a common and important complication after abdominal surgery, with severity showing a graded association with mortality and hospital stay. Individualized blood pressure management demonstrates promise in AKI prevention.

Registration: PROSPERO CRD42022304083.

Keywords: Acute kidney injury; abdominal surgery; incidence; risk factor; systematic review.

Plain language summary

The incidence of postoperative AKI after abdominal surgery is 16% (95% CI: 14–17%), varying by specific abdominal surgical procedure but not significantly different over time or by consensus definition.AKI severity shows a strong graded association with both short-term and long-term mortality, as well as prolonged hospital stays.Twenty-five factors were identified, providing valuable information for clinical risk assessment.Meta-analysis of randomized trials reveals that individualized blood pressure target management significantly reduces AKI incidence, while other single perioperative interventions (crystalloids versus colloids, restrictive versus liberal fluid management, cardiac output-guided therapy, hemodynamic monitoring) show no significant protective effects.

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Conflict of interest statement

No conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Flow diagram for study selection.
Figure 2.
Figure 2.
Forest plot of hospital LOS of patients who developed postoperative AKI and those who did not.
Figure 3.
Figure 3.
Forest plot of the risk ratio of the association between AKI and mortality.
Figure 4.
Figure 4.
Forest plot of the risk factors for postoperative AKI. Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BMI, body mass index; COPD, chronic obstructive pulmonary disease; NSAID, non-steroidal anti-inflammatory drug; RBC, red blood cell. PNI, prognostic nutritional index, PNI= [10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count (per mm3)].
Figure 5.
Figure 5.
Meta-analysis of perioperative hemodynamic interventions on postoperative acute kidney injury. Forest plots showing risk ratios and 95% CI for different perioperative hemodynamic intervention strategies. (A) Individualized blood pressure target management; (B) Colloids versus crystalloids; (C) Restrictive versus liberal fluid management; (D) Cardiac output-guided therapy; (E) Hemodynamic monitoring-guided management.
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References

    1. Ronco C, Bellomo R, Kellum JA.. Acute kidney injury. Lancet. 2019;394(10212):1949–1964. doi: 10.1016/s0140-6736(19)32563-2. - DOI - PubMed
    1. Futier E, Garot M, Godet T, et al. Effect of hydroxyethyl starch vs saline for volume replacement therapy on death or postoperative complications among high-risk patients undergoing major abdominal surgery. JAMA. 2020;323(3):225–236. doi: 10.1001/jama.2019.20833. - DOI - PMC - PubMed
    1. Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, et al. Cost and mortality associated with postoperative acute kidney injury. Ann Surg. 2015;261(6):1207–1214. PubMed Central PMCID: PMC4247993. doi: 10.1097/SLA.0000000000000732. - DOI - PMC - PubMed
    1. Selby NM, Taal MW.. Long-term outcomes after AKI-a major unmet clinical need. Kidney Int. 2019;95(1):21–23. doi: 10.1016/j.kint.2018.09.005. - DOI - PubMed
    1. See EJ, Jayasinghe K, Glassford N, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95(1):160–172. doi: 10.1016/j.kint.2018.08.036. - DOI - PubMed

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