Development of chronic kidney disease after major surgery

Abstract

Abstract Purpose Chronic kidney disease (CKD) is a significant health care burden worldwide. However, little is known about its development after major surgery. Methods We conducted an international prospective, observational, multi-center study in 30 countries among patients undergoing major surgery. The primary study endpoint was the incidence of CKD (defined as new onset CKD with an eGFR < 60ml/min/1.73m2 at day 90). Secondary endpoints included the relationship between early postoperative-AKI (within 72h after major surgery) and development of postoperative CKD, the identification of risk factors for CKD, and the rate and risk factors for CKD progression in patients with pre-existing CKD. Results We studied 9,510 patients without pre-existing CKD. Of these, 940 (9.9%) developed CKD with 34.2% experiencing an episode of early postoperative-AKI. CKD rates significantly increased with the severity of early AKI (19.1% KDIGO1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001). Independent risk factors for CKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for CKD of 2.64 (95%-CI 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90 as defined. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion One in ten major surgery patients developed postoperative CKD, most of them without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration was associated with an increased rate of CKD with early postoperative-AKI being a major independent risk factor for CKD. Clinical trial number: The study was registered at ClinicalTrials.gov (NCT04165369).