Incidence, Risk Factors and Outcome of Postoperative Acute Kidney Injury in China

Yichun Cheng; Sheng Nie; Xingyang Zhao; Xin Xu; Hong Xu; Bicheng Liu; Jianping Weng; Chunbo Chen; Huafeng Liu; Qiongqiong Yang; Hua Li; Yaozhong Kong; Guisen Li; Qijun Wan; Yan Zha; Ying Hu; Yongjun Shi; Yilun Zhou; Guobin Su; Ying Tang; Mengchun Gong; Fan Fan Hou; Shuwang Ge; Gang Xu

doi:10.1093/ndt/gfad260

Incidence, Risk Factors and Outcome of Postoperative Acute Kidney Injury in China

Nephrol Dial Transplant. 2024 Jan 23:gfad260. doi: 10.1093/ndt/gfad260. Online ahead of print.

Authors

Yichun Cheng¹, Sheng Nie², Xingyang Zhao¹, Xin Xu², Hong Xu³, Bicheng Liu⁴, Jianping Weng⁵, Chunbo Chen⁶, Huafeng Liu⁷, Qiongqiong Yang⁸, Hua Li⁹, Yaozhong Kong¹⁰, Guisen Li¹¹, Qijun Wan¹², Yan Zha¹³, Ying Hu¹⁴, Yongjun Shi¹⁵, Yilun Zhou¹⁶, Guobin Su¹⁷, Ying Tang¹⁸, Mengchun Gong^{19

20}, Fan Fan Hou², Shuwang Ge¹, Gang Xu¹

Affiliations

¹ Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.
² Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research.
³ Children's Hospital of Fudan University.
⁴ Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine.
⁵ Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China.
⁶ Department of Critical Care Medicine, Maoming People's Hospital, Maoming.
⁷ Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University.
⁸ Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
⁹ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine.
¹⁰ Department of Nephrology, the First People's Hospital of Foshan.
¹¹ Renal Department and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases.
¹² The Second People's Hospital of Shenzhen, Shenzhen University.
¹³ Guizhou Provincial People's Hospital, Guizhou University.
¹⁴ The Second Affiliated Hospital of Zhejiang University School of Medicine.
¹⁵ Huizhou Municipal Central Hospital, Sun Yat-Sen University.
¹⁶ Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University.
¹⁷ Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine.
¹⁸ The Third Affiliated Hospital of Southern Medical University.
¹⁹ Institute of Health Management, Southern Medical University, DHC Technologies.
²⁰ DHC Technologies, Beijing, China.

PMID: 38262746
DOI: 10.1093/ndt/gfad260

Abstract

Background and hypothesis: Postoperative acute kidney injury (AKI) is a common condition after surgery, however, the available data about nationwide epidemiology of postoperative AKI in China from the large and high-quality studies is limited. This study was aimed to determine the incidence, risk factors, and outcomes of postoperative AKI among patients undergoing surgery in China.

Methods: This was a large, multicenter, retrospective study performed in 16 tertiary medical centers in China. Adult (at least 18 years old) patients who undergoing surgical procedures from January 1, 2013 to December 31, 2019 were included. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes creatinine criteria. The associations of AKI and in-hospital outcomes were investigated using logistic regression models adjusted for potential confounders.

Results: Among 520 707 patients included in our study, 25 830 (5.0%) patients developed postoperative AKI. The incidence of postoperative AKI varied by surgery type, which was highest in cardiac (34.6%) surgery, followed by urologic (8.7%), and general (4.2%) surgeries. 89.2% postoperative AKI cases were detected in the first 2 postoperative days. However, only 584 (2.3%) patients with postoperative AKI were diagnosed with AKI on discharge. Risk factors for postoperative AKI included advanced age, male sex, lower baseline kidney function, pre-surgery hospital stay ≤ 3 days or > 7 days, hypertension, diabetes mellitus, and use of PPIs or diuretics. The risk of in-hospital death increased with the stage of AKI. In addition, patients with postoperative AKI had longer length of hospital stay (12 vs 19 days), were more likely to require intensive unit care (13.1% vs 45.0%) and renal replacement therapy (0.4% vs 7.7%).

Conclusions: Postoperative AKI was common across surgery type in China, particularly for patients undergoing cardiac surgery. Implementation and evaluation of an alarm system is important for the battle against postoperative AKI.

Keywords: acute kidney injury; in-hospital death; surgery.