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Renal recovery and long‐term survival following acute kidney injury after coronary artery surgery: a nationwide study
Author(s) -
Helgadottir S.,
Sigurdsson M. I.,
Palsson R.,
Helgason D.,
Sigurdsson G. H.,
Gudbjartsson T.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12758
Subject(s) - medicine , acute kidney injury , renal function , creatinine , kidney disease , diabetes mellitus , incidence (geometry) , risk factor , surgery , cardiology , endocrinology , physics , optics
Background Acute kidney injury (AKI) is a relatively common complication following CABG and is associated with adverse outcomes. Nonetheless, we hypothesized that the majority of patients make a good long‐term recovery of their renal function. We studied the incidence and risk factors of AKI together with renal recovery and long‐term survival in patients who developed AKI following CABG. Methods This nationwide study examined AKI among 1754 consecutive patients undergoing CABG in 2001–2013. AKI was defined according to the KDIGO criteria. Results Postoperatively 184 (11%) patients developed AKI; 121 (7%), 27 (2%), and 36 (2%) at stages 1, 2, and 3, respectively. AKI was an independent risk factor for chronic kidney disease (CKD) and AKI patients had worse post‐operative outcomes. Lower pre‐operative glomerular filtration rate, higher EuroSCORE and BMI, diabetes, reoperation, and units of red blood cells transfused were independent risk factors of AKI. At post‐operative day 10, renal recovery rates, defined as serum creatinine ratio <1.25 of baseline, were 96 (95% CI 91–99%), 78 (95% CI 53–90%), and 94% (95% CI 77–98%) for AKI stages 1, 2, and 3, respectively. Long‐term survival was predicted by AKI with 10‐year survival of patients without AKI being 76% and those with AKI stages 1, 2, and 3 being 63%, 56%, and 49%, respectively ( P < 0.001). Conclusion Depending on the severity of the initial AKI, 78–97% of patients made good recovery of their kidney function. However, AKI was significantly linked to progression to CKD and long‐term survival remained markedly affected by the severity of the initial kidney injury.