Skip to Main content Skip to Navigation
Journal articles

Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury

Abstract : Background: The potential relationship between a mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery and its effect on long term renal function remains poorly defined. According to the "Kidney Disease: Improving Global Outcomes" (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-h window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent intermediate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI. Methods: All consecutive adult patients with a plasma creatinine value ≤1.5 mg/dl who underwent intermediate-to high-risk abdominal surgery between 2014 and 2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a "modified" (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-h or 1.5-1.9 times baseline) or moderate-to-severe (stage 2-3 characterised by increase in creatinine 2 to 3 times baseline or to ≥4.0 mg/dl). The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the same KDIGO initiative criteria. Development of long-term renal injury was compared in patients with and without postoperative AKI. Results: Among the 815 patients included, 109 (13%) had postoperative AKI (81 mild and 28 moderate-to-severe). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P = 0.2). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7-5.5]; p < 0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8-11.4]; p = 0.002). Conclusions: Mild AKI after intermediate-to high-risk abdominal surgery is associated with a higher risk of long-term renal injury 1 y after surgery.
Document type :
Journal articles
Complete list of metadata

https://www.hal.inserm.fr/inserm-03311973
Contributor : Odile Malbec Connect in order to contact the contributor
Submitted on : Monday, August 2, 2021 - 10:51:38 AM
Last modification on : Tuesday, October 19, 2021 - 12:55:43 PM

File

s12871-021-01353-2.pdf
Publisher files allowed on an open archive

Identifiers

Citation

Alexandre Joosten, Brigitte Ickx, Zakaria Mokthari, Luc van Obbergh, Valerio Lucidi, et al.. Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury. BMC Anesthesiology, BioMed Central, 2021, 21 (1), pp.135. ⟨10.1186/s12871-021-01353-2⟩. ⟨inserm-03311973⟩

Share

Metrics

Record views

17

Files downloads

35