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dc.contributor.authorPrivratsky, Jamie R
dc.contributor.authorKrishnamoorthy, Vijay
dc.contributor.authorRaghunathan, Karthik
dc.contributor.authorOhnuma, Tetsu
dc.contributor.authorRasouli, Mohammad R
dc.contributor.authorLong, Thorir E
dc.contributor.authorSigurdsson, Martin I
dc.date.accessioned2022-02-24T15:49:26Z
dc.date.available2022-02-24T15:49:26Z
dc.date.issued2022-01
dc.date.submitted2022-02
dc.identifier.citationPrivratsky JR, Krishnamoorthy V, Raghunathan K, et al. Postoperative Acute Kidney Injury Is Associated With Progression of Chronic Kidney Disease Independent of Severity. Anesth Analg. 2022;134(1):49-58. doi:10.1213/ANE.0000000000005702en_US
dc.identifier.pmid34908546
dc.identifier.doi10.1213/ANE.0000000000005702
dc.identifier.urihttp://hdl.handle.net/2336/622081
dc.descriptionTo access publisher's full text version of this article click on the hyperlink belowen_US
dc.description.abstractBackground: Both postoperative acute kidney injury (AKI) and preoperative chronic kidney disease (CKD) are associated with significantly worse outcomes following surgery. The relationship of both of these conditions with each other and with CKD progression after surgery remains poorly studied. Our objective was to assess if there was an interaction between preoperative kidney function estimated by preoperative estimated glomerular filtration rate (eGFR)/CKD stage, postoperative AKI, and eGFR/CKD progression within 1 year of surgery. Our hypothesis was that AKI severity would be associated with a faster time to eGFR/CKD stage progression within 1 year of surgery in a graded-fashion, which would be exacerbated by preoperative kidney dysfunction. Methods: This was a retrospective cohort study at Landspitali University Hospital in Iceland, which serves about 75% of the population. Participants included adults receiving their first major anesthetic between 2005 and 2018. Patients with CKD stage 5, undergoing major urologic procedures, or having missing creatinine values for follow-up of eGFR stage were excluded from analysis. The primary exposure was postoperative AKI stage within 7 days after surgery classified by the kidney disease improving global outcome (KDIGO) criteria. The primary outcome was time to progression of CKD by at least 1 eGFR/CKD stage within 1-year following surgery. Multivariable Cox proportional hazards models were used to estimate hazard of eGFR/CKD stage progression, including an interaction between AKI and preoperative CKD on eGFR/CKD stage progression. Results: A total of 5548 patients were studied. In the multivariable model adjusting for baseline eGFR/CKD stage, when compared to patients without AKI, postoperative AKI stage 1 (hazard ratio [HR], 5.91; 95% confidence interval [CI], 4.34-8.05), stage 2 (HR, 3.86; 95% CI, 1.82-8.16), and stage 3 (HR, 3.61; 95% CI, 1.49-8.74) were all independently associated with faster time to eGFR/CKD stage progression within 1 year following surgery, though increasing AKI severity did not confer additional risk. The only significant interaction between the degree of AKI and the preexisting renal function was for stage 1 AKI, where the odds of 1-year eGFR/CKD stage progression actually decreased in patients with preoperative CKD categories 3a, 3b, and 4. Conclusions: KDIGO-AKI was independently associated with eGFR/CKD stage progression within the year following surgery after adjustment for baseline eGFR/CKD stage and without an interaction between worse preoperative kidney function and higher stage AKI. Our observations suggest that further studies are warranted to test whether CKD progression could be prevented by the adoption of perioperative kidney protective practices.en_US
dc.language.isoenen_US
dc.publisherLippincott Williams & Wilkinsen_US
dc.relation.urlhttps://journals.lww.com/anesthesia-analgesia/Fulltext/2022/01000/Postoperative_Acute_Kidney_Injury_Is_Associated.11.aspxen_US
dc.rightsCopyright © 2021 International Anesthesia Research Society.
dc.subjectSkurðlækningaren_US
dc.subjectNýrnabilunen_US
dc.subjectNýrnasjúkdómaren_US
dc.subject.meshAcute Kidney Injuryen_US
dc.subject.meshDisease Progressionen_US
dc.subject.meshPostoperative Perioden_US
dc.subject.meshRenal Insufficiency, Chronicen_US
dc.titlePostoperative Acute Kidney Injury Is Associated With Progression of Chronic Kidney Disease Independent of Severity.en_US
dc.typeArticleen_US
dc.identifier.eissn1526-7598
dc.contributor.department1From the Critical Care and Perioperative Population Health Research (CAPER) Unit. 2Center for Perioperative Organ Protection (CPOP), Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina. 3Anesthesiology Service Division, Durham Veterans Affairs Medical Center, Durham, North Carolina. 4Department of Anesthesiology, Stanford University, Palo Alto, California. 5Division of Nephrology, Department of Medicine. 6Division of Anesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 7Faculty of Medicine, University of Iceland, Reykjavik, Iceland.en_US
dc.identifier.journalAnesthesia and analgesiaen_US
dc.rights.accessLandspitali Access - LSH-aðganguren_US
dc.departmentcodeAAA12
dc.departmentcodeNEP12
dc.source.journaltitleAnesthesia and analgesia
dc.source.volume134
dc.source.issue1
dc.source.beginpage49
dc.source.endpage58
dc.source.countryUnited States


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