From the Departments of Outcomes Research (A.T., B.C., J.A., N.M., L.L., E.J.M., Y.Q., K.R., D.I.S.) General Anesthesia (A.T., S.I., B.J.W., K.R.) Quantitative Health Sciences (N.M., L.L., E.J.M.), Cleveland Clinic, Cleveland, Ohio the Division of Anesthesia, Critical Care and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (B.C.).
Anesthesiology. 2020 May;132(5):1053-1061. doi: 10.1097/ALN.0000000000003109.
Perioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and do not experience mild kidney injury after noncardiac surgery are at similar risk for long-term renal injury.
This study is a retrospective cohort analysis of adults having noncardiac surgery at the Cleveland Clinic who had preoperative, postoperative, and long-term (1 to 2 yr after surgery) plasma creatinine measurements. The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) initiative criteria. The primary analysis was for lack of association between postoperative kidney injury (stage I vs. no injury) and long-term renal injury.
Among 15,621 patients analyzed, 3% had postoperative stage I kidney injury. Long-term renal outcomes were not similar in patients with and without postoperative stage I injury. Specifically, about 26% of patients with stage I postoperative kidney injury still had mild injury 1 to 2 yr later, and 11% had even more severe injury. A full third (37%) of patients with stage I kidney injury therefore had renal injury 1 to 2 yr after surgery. Patients with postoperative stage I injury had an estimated 2.4 times higher odds of having long-term renal dysfunction (KDIGO stage I, II, or III) compared with patients without postoperative kidney injury (odds ratio [95% CI] of 2.4 [2.0 to 3.0]) after adjustment for potential confounding factors.
In adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.
围手术期急性肾损伤很常见。然而，目前尚不清楚这仅仅代表肌酐的一过性升高，还是具有预后价值。因此，轻度术后急性肾损伤的长期临床重要性仍不清楚。本研究评估了经历和未经历非心脏手术后轻度肾损伤的成年人在长期（手术后 1 至 2 年）肾损伤方面是否存在相似的风险。
这是克利夫兰诊所接受非心脏手术的成年人的回顾性队列分析，这些患者术前、术后以及长期（术后 1 至 2 年）都有血浆肌酐测量值。根据肾脏疾病：改善全球结局（KDIGO）倡议标准定义暴露（术后肾损伤）和结局（长期肾损伤），并进行分期。主要分析是评估术后肾损伤（I 期与无损伤）与长期肾损伤之间是否存在关联。
在分析的 15621 例患者中，3%的患者发生术后 I 期肾损伤。有和无术后 I 期损伤的患者的长期肾结局并不相似。具体而言，约 26%的术后 I 期肾损伤患者在 1 至 2 年后仍有轻度损伤，11%的患者甚至有更严重的损伤。因此，37%的 I 期术后肾损伤患者在手术后 1 至 2 年内出现了肾损伤。与无术后肾损伤的患者相比，术后 I 期损伤患者发生长期肾功能障碍（KDIGO Ⅰ、Ⅱ或Ⅲ期）的估计风险高 2.4 倍（调整潜在混杂因素后比值比[95%CI]为 2.4[2.0 至 3.0]）。
在从非心脏手术中恢复的成年人中，即使是血浆肌酐的小幅度升高，对应于 I 期肾损伤，也与术后 1 至 2 年内的肾功能障碍相关。因此，即使是轻度术后肾损伤也应被视为围手术期具有临床重要意义的结果。
