Acute Kidney Injury: A Modifiable Risk Factor for Cardiovascular Morbidity and Mortality

spectively. AKI, defined as at least a ≥ 26.4 μmol/l or 1.5 fold increase in serum creatinine from preoperative baseline, occurred in 188 (19.8%) subjects. AKI was independently associated with cardiovascular events (composite cardiovascular end point: non-fatal myocardial infarction, non-fatal stroke, non-fatal peripheral vascular events, hospitalization due to heart failure, and death) with a hazard ratio (95% CI) 1.73 (1.0–3.39); p = 0.03. In addition to their own prospectively collected data, the authors also performed a meta-analysis that reiterated their findings in previously published retrospective studies of patients undergoing other cardiovascular interventions (e.g. primarily percutaneous coronary interventions). The meta-analysis, which included 12 separate studies in its final analyses, revealed an increased cardiovascular relative risk (RR) for patients undergoing PCI (RR (95% CI) 1.76 (1.45–2.12); p < 0.001, I 2 = 50.6% at 1 year, RR (95% CI) 1.34 (1.10–1.63); p = 0.003, I 2 = 33.9% at 2 years) and cardiac surgery (RR (95% CI) 1.60 (1.43–1.81), I 2 = 0% at 5 years). Acute kidney injury (AKI) occurs in a significant proportion of patients undergoing cardiovascular interventions and is associated with long-term morbidity and mortality in patients undergoing both non-cardiac surgery and cardiac surgery [1–4] . In a systemic review of 13 cohort studies, Coca et al. [5] identified AKI as an independent risk factor for the development of chronic kidney disease and its most severe form, the end-stage renal disease. In addition to these associations, longer duration of postoperative AKI has also been linked with increased long-term, all-cause mortality [4] . In this edition of the American Journal of Nephrology , Saratzis and colleagues, further strengthen these associations by demonstrating increased risk of cardiovascular morbidity and mortality in those with a prior history of post-operative AKI [6] . In their prospectively collected multicenter cohort of patients undergoing elective abdominal aortic aneurysm repair (endovascular or open), they concluded that after adjusting for known cardiovascular risk factors, AKI, regardless of surgical technique, was associated with increased long-term cardiovascular morbidity and mortality. In their cohort of 947 subjects (median follow-up of 62 months), mortality rates of 11.8 and 8.3% were observed for patients undergoing endovascular and open repair rePublished online: October 24, 2015 Nephrology American Journal of