Cardio- and Cerebrovascular Outcomes of Postoperative Acute Kidney Injury in Noncardiac Surgical Patients With Hypertension

Yan Guangyu; Lou Jingfeng; Liu Xing; Yuan Hong; Lu Yao

doi:10.3389/fphar.2021.696456

Cardio- and Cerebrovascular Outcomes of Postoperative Acute Kidney Injury in Noncardiac Surgical Patients With Hypertension

Front Pharmacol. 2021 Aug 27:12:696456. doi: 10.3389/fphar.2021.696456. eCollection 2021.

Authors

Yan Guangyu^{1

2}, Lou Jingfeng¹, Liu Xing³, Yuan Hong¹, Lu Yao^{1

4

5}

Affiliations

¹ Center of Clinical Research, The Third Xiangya Hospital, Central South University, Changsha, China.
² Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.
³ Department of Anesthesia, The Third Xiangya Hospital, Central South University, Changsha, China.
⁴ Department of Life Science and Medicine, King's College London, London, United Kingdom.
⁵ Key Laboratory of Medical Information Research(Central South University), College of Hunan Province, Changsha, China.

Abstract

Background: The cardiovascular and cerebrovascular risk of postoperative acute kidney injury (AKI) in surgical patients is poorly described, especially in the hypertensive population. Methods: We conducted a retrospective cohort study among all hypertensive patients who underwent elective noncardiac surgery from January 1st, 2012 to August 1st, 2017 at the Third Xiangya Hospital. The primary outcomes were fatal stroke and fatal myocardial infarction (MI). The secondary outcomes were all-cause mortality. Results: The postoperative cumulative mortality within 3 months, 6 months, 1 year, 2 years, and 5 years were 1.27, 1.48, 2.15, 2.15, and 5.36%, for fatal stroke, and 2.05, 2.27, 2.70, 3.37, and 5.61% for fatal MI, respectively, in patients with postoperative AKI. Compared with non-AKI patients, those with postoperative AKI had a significantly higher risk of fatal stroke and fatal MI within 3 months [hazard ratio (HR): 5.49 (95% CI: 1.88-16.00) and 11.82 (95% CI: 4.56-30.62), respectively], 6 months [HR: 3.58 (95% CI: 1.43-8.97) and 9.23 (95% CI: 3.89-21.90), respectively], 1 year [HR: 3.64 (95% CI: 1.63-8.10) and 5.14 (95% CI: 2.50-10.57), respectively], 2 years [HR: 2.21 (95% CI: 1.03-4.72) and 3.06 (95% CI: 1.66-5.64), respectively], and 5 years [HR: 2.27 (95% CI: 1.30-3.98) and 1.98 (95% CI: 1.16-3.20), respectively]. In subgroup analysis of perioperative blood pressure (BP) lowering administration, postoperative AKI was significantly associated with 1-year and 5-year risk of fatal stroke [HR: 9.46 (95% CI: 2.85-31.40) and 3.88 (95% CI: 1.67-9.01), respectively] in patients with ACEI/ARB, and MI [HR: 6.62 (95% CI: 2.23-19.62) and 2.44 (95% CI: 1.22-4.90), respectively] in patients with CCB. Conclusion: Hypertensive patients with postoperative AKI have a significantly higher risk of fatal stroke and fatal MI, as well as all-cause mortality, within 5 years after elective noncardiac surgery. In patients with perioperative administration of ACEI/ARB and CCB, postoperative AKI was significantly associated with higher risk of fatal stroke and MI, respectively.

Keywords: acute kidney injury; cardiovascular and cerebrovascular outcomes; hypertension; mortality; noncardiac surgery.