Kidney Injury Common Following Vascular Surgery

Perioperative acute kidney injury (AKI) is common in patients undergoing vascular surgery, and is associated with a high risk for cardiovascular-specific mortality, according to a new study.

Researchers at the University of Florida (Gainesville, USA) conducted a single-center study involving 3,646 patients over a period of ten years to determine the association between kidney disease and long-term cardiovascular-specific mortality following vascular surgery. The main outcomes and measures of the study were perioperative AKI, presence of chronic kidney disease (CKD), and overall and cause-specific mortality. Kidney disease constituted the main covariate, after adjusting for baseline patient characteristics, surgery type, and admission hemoglobin level.

The results showed that perioperative AKI occurred in 49% of the patients, with CKD present in 14%. The top two causes of death in the study cohort were cardiovascular disease (54%) and cancer (11%). The adjusted cardiovascular mortality estimates at 10 years were 17% for patients with no kidney disease; 31% for patients with AKI without CKD; 30% for patients with CKD without AKI; and 41% for patients with both AKI and CKD. The study was published on December 23, 2015, in JAMA Surgery.

“These findings reinforce the importance of preoperative risk stratification through application of consensus staging criteria for CKD using estimated glomerular filtration rate and albuminuria for all patients undergoing major vascular surgery,” concluded lead author Azra Bihorac, MD. “Risk stratification for AKI using clinical scores and urinary biomarkers similarly can help to direct the implementation of simple and inexpensive preventive strategies in the perioperative period that could prevent or mitigate further decline in kidney function.”

AKI is an abrupt loss of kidney function that develops within 7 days and is generally caused by renal ischemia, exposure to harmful substances, an inflammatory process in the kidney, or an obstruction of the urinary tract which impedes the flow of urine. AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects on other organ systems. Those who experience AKI may have an increased risk of CKD in the future. Management includes treatment of the underlying cause and supportive care, such as renal replacement therapy.

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