Stannard Blaine, Epstein Richard H, Gabel Eilon, Nadkarni Girish N, Ouyang Yuxia, Lin Hung-Mo, Salari Valiollah, Hofer Ira S
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA.
BJA Open. 2025 Mar 6;14:100384. doi: 10.1016/j.bjao.2025.100384. eCollection 2025 Jun.
The risk of developing a persistent reduction in renal function after postoperative acute kidney injury (pAKI) is not well established. The goal of this investigation was to evaluate whether patients who develop pAKI have a greater decline in long-term renal function than patients who do not.
In this multicentre retrospective propensity-matched study, anaesthesia data warehouses at three tertiary care hospitals were queried. Adult patients undergoing surgery with available preoperative and postoperative creatinine results and without baseline haemodialysis requirements were included. Patients were stratified by occurrence of pAKI as defined by the Acute Kidney Injury Network classification. The primary outcome was a decline in follow-up glomerular filtration rate (GFR) of 40% relative to baseline, based on follow-up outpatient visits from 0 to 36 months after hospital discharge. A propensity score-matched sample was used in Kaplan-Meier analysis and a piecewise Cox model to compare the time to reach a 40% decline in GFR for patients with and without pAKI.
In 95 213 patients, the rate of pAKI ranged from 9.9% to 13.7%. In the piecewise Cox model, pAKI was associated with a significantly increased hazard of a 40% decline in GFR. The common-effect hazard ratio was 13.35 (95% confidence interval [CI] 10.79-16.51, <0.001) for 0-6 months, 7.07 (5.52-9.05, <0.001) for 6-12 months, 6.02 (4.69-7.74, <0.001) for 12-24 months, and 4.32 (2.65-7.05, <0.001) for 24-36 months.
pAKI is associated with a significantly increased hazard of a 40% decline in GFR up to 36 months after surgery across three institutions.
术后急性肾损伤（pAKI）后肾功能持续下降的风险尚未明确。本研究的目的是评估发生pAKI的患者与未发生pAKI的患者相比，长期肾功能下降是否更明显。
在这项多中心回顾性倾向匹配研究中，查询了三家三级护理医院的麻醉数据仓库。纳入术前和术后肌酐结果可用且无基线血液透析需求的成年手术患者。根据急性肾损伤网络分类定义的pAKI发生情况对患者进行分层。主要结局是出院后0至36个月的门诊随访中，随访肾小球滤过率（GFR）相对于基线下降40%。在Kaplan-Meier分析和分段Cox模型中使用倾向评分匹配样本，以比较发生和未发生pAKI的患者达到GFR下降40%的时间。
在95213例患者中，pAKI发生率为9.9%至13.7%。在分段Cox模型中，pAKI与GFR下降40%的风险显著增加相关。0至6个月的共同效应风险比为13.35（95%置信区间[CI]10.79-16.51，<0.001），6至12个月为7.07（5.52-9.05，<0.001），12至24个月为6.02（4.69-7.74，<
