University of Florida researchers have shown that patients with acute kidney injury (AKI) or chronic kidney disease (CKD) are significantly more likely to die from complications following cardiovascular surgery than those without kidney injury or disease.
The study,“Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery” by Matthew Huber and colleagues, and published online in the journal JAMA Surgery, included 3,646 patients (who were hospitalized with CKD, developed perioperative AKI during hospitalization, or had no kidney pathology) undergoing vascular surgery at a single center between 2000 and 2010.
The results demonstrated that either acute or chronic kidney disease was associated with a doubled risk of dying due to cardiovascular disease following surgery. When calculating the risk for both groups combined, kidney disease patients had a threefold increased risk of mortality.
Cardiovascular disease was the leading cause of death in the study, accounting for 53.6 percent, followed by cancer at 11 percent. Stage I AKI is often not considered to constitute true organ damage by clinicians. The study, however, shows that this group suffers a significantly higher risk of death in cardiovascular disease.
Kidney disease was not the only factor in mortality risk following surgery — older age, low Hb levels, and emergency surgery also contributed.
The authors suggest that risk assessment, using glomerular filtration rate and albuminuria, could be used to stratify patients into different risk groups, and to help implement preventive strategies to reduce the decline in kidney function.
In an invited commentary to the article, Christian de Virgilio and Dennis Yong Kim from the Harbor-UCLA Medical Center encouraged the healthcare professionals to pay closer attention to postoperative AKI. “Novel biomarkers may furnish physicians with a narrow window to reverse or altogether avoid the development of AKI. Goal-directed intraoperative measures to maximize renal perfusion and the early use of renal replacement therapy may also have a role in prevention and treatment, respectively. Perhaps, even more exciting is the application of preoperative therapeutic interventions such as remote ischemic preconditioning, which in a recent trial was associated with a significantly reduced rate of AKI following cardiac surgery,” they wrote.