Transient acute kidney injury after major abdominal surgery increases chronic kidney disease risk and 1-year mortality

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Purpose:We conducted a retrospective cohort study to determine incidences of transient and persistent acute kidney injury (AKI) after major abdominal surgery and their impacts on long-term outcome.Materials and methods:We enrolled 3751 patients undergoing major abdominal surgery. Postoperative AKI was classified as transient or persistent based on the return of serum creatinine to the non-AKI range within 7days post-surgery. Primary outcome was mortality within 1year. We used multivariable Cox proportional hazard regression analysis to assess independent associations between AKI type and mortality.Results:Most patients with AKI were classified as transient (84%). Compared to patients without AKI, both patients with transient and persistent AKI demonstrated elevated 1-year mortality rates [adjusted hazard ratio (95% confidence interval): 2.01 (1.34–2.93); P=0.001, and 6.20 (3.00–11.43); P<0.001, respectively] and greater risk of chronic kidney disease progression at 1year [adjusted odds ratio (95% confidence interval): 3.87 (2.12–7.08) and 23.70 (9.64–58.22), respectively; both P<0.001].Conclusions:Although most AKI cases after major abdominal surgery recover completely within 7days, even these patients with transient AKI are at higher risk for 1-year mortality and chronic kidney disease progression compared to patients without AKI.HIGHLIGHTSThe majority of AKI cases after major abdominal surgery abated within one week.However, even transient AKI was associated with higher 1-year mortality.Patients with transient AKI were also at higher risk of CKD progression at 1year.Both transient and persistent AKI warrant careful follow-up and intervention.

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