Postdischarge long-term cardiovascular outcomes of intensive care unit survivors who developed dialysis-requiring acute kidney injury after cardiac surgery


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Abstract

Purpose:Dialysis-requiring acute kidney injury (AKI-D) after cardiac surgery is a major cause of in-hospital mortality. However, the long-term outcome has not been previously examined.Materials and methods:We performed a nationwide, population-based cohort study using the claims data in the Korean National Health Insurance System. Patients who underwent cardiac surgery between 2006 and 2015 were considered.Results:Among 52,983 patients who underwent cardiac surgery, 1261 underwent dialysis postoperatively. During the median follow-up of 3.33years, the AKI-D group had increased risk of all-cause mortality, end-stage renal disease (ESRD) progression, and risk of developing major adverse cardiovascular events (MACEs). These results remained consistent after multivariable analysis and propensity-score matching. Even after excluding patients who continued dialysis at discharge, the AKI-D group consistently exhibited worse mortality and an increased risk of MACEs compared to the control group. Patients who underwent continuous renal replacement therapy in the AKI-D group exhibited comparable mortality and risk of MACEs but reduced progression to ESRD compared to those who received intermittent renal replacement therapy.Conclusions:AKI-D following cardiac surgery was associated with worse long-term postdischarge mortality and elevated risks of dialysis dependency and MACE development. The outcomes were consistent even in the patients who recovered from the dialysis.HIGHLIGHTSWe examined the impact of dialysis-requiring AKI following cardiac surgery.AKI-D after cardiac surgery is associated with worse long-term prognosis.Postdischarge patients who recovered from AKI-D exhibited poor long-term outcomes.

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