Progression of chronic kidney disease after non-cardiac surgery: A retrospective cohort study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-01-16 DOI:10.1016/j.jclinane.2025.111745

Julian Rössler M.D. , Sascha Ott M.D. , Yufei Li M.S. , Alparslan Turan M.D. , Mehmet Yazar M.D. , Lukas M. Müller-Wirtz M.D. , Sevag Demirjian M.D. , Andrew Shaw M.D. , Kurt Ruetzler M.D.

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引用次数: 0

Abstract

Background

Chronic-kidney-disease (CKD) is prevalent among adults undergoing noncardiac surgery, with surgery-related factors potentially worsening CKD or triggering acute kidney injury (AKI). We hypothesized that CKD patients experience more kidney function decline within one to two years post-surgery than those without CKD, particularly if they develop AKI.

Methods

We conducted a single-center retrospective cohort study, including noncardiac surgery patients with documented creatinine preoperative and between 1 and 2 years after surgery. The primary outcome was long-term course of kidney function, defined as the change in estimated glomerular filtration rate (eGFR) in mL/min/1.73m².

Results

Of 58,175 included cases, 17 % had preoperative CKD. Mean eGFR changed from 90.1 ± 16.7 to 92.0 ± 18.8 in non-CKD patients and from 45.6 ± 11.9 to 55.6 ± 20.1 in patients with CKD, with an estimated difference in means of 8.9 (95 % CI: 8.5, 9.3; P < 0.0001). There was a significant interaction between CKD-dependent eGFR change from baseline to follow-up and postoperative AKI (P = 0.001). For cases with preoperative CKD, eGFR increase from baseline to follow-up was 11.7 ± 18.0 with no AKI, 7.7 ± 17.9 with AKI stage 1, 2.4 ± 15.0 with AKI stage 2, and 7.3 ± 25.8 with AKI stage 3. For non-CKD patients, eGFR increased from baseline by 2.3 ± 13.7 with no AKI but decreased by 5.5 ± 19.0 with AKI stage 1, 7.7 ± 21.8 with AKI stage 2, and 9.3 ± 21.3 with AKI stage 3.

Conclusions

Contrary to expectations, patients with preoperative CKD experienced a significant improvement in eGFR postoperatively. Patients without CKD exhibited minimal change. Postoperative AKI negated the eGFR improvement in CKD patients and exacerbated the decline in non-CKD patients.

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非心脏手术后慢性肾脏疾病的进展：一项回顾性队列研究

背景：慢性肾脏疾病（CKD）在接受非心脏手术的成年人中很普遍，手术相关因素可能会加重CKD或引发急性肾损伤（AKI）。我们假设CKD患者在术后一到两年内比非CKD患者经历更多的肾功能下降，特别是如果他们发展为AKI。方法：我们进行了一项单中心回顾性队列研究，包括术前和术后1 - 2年有肌酸酐记录的非心脏手术患者。主要终点是肾功能的长期病程，定义为肾小球滤过率（eGFR）的估计变化（mL/min/1.73m2）。结果：58,175例纳入病例中，17%术前有CKD。非CKD患者的平均eGFR从90.1±16.7变化到92.0±18.8，CKD患者的平均eGFR从45.6±11.9变化到55.6±20.1，估计平均值差异为8.9 (95% CI: 8.5, 9.3；结论：与预期相反，术前CKD患者术后eGFR有显著改善。没有CKD的患者表现出最小的变化。术后AKI否定了CKD患者eGFR的改善，加剧了非CKD患者eGFR的下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.