Original InvestigationPathogenesis and Treatment of Kidney DiseaseAcute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data
Section snippets
Study Population
The study population was derived from a large cohort consisting of all patients with estimated glomerular filtration rates (eGFRs) ≥ 60 mL/min/1.73 m2 (calculated by the CKD-EPI [CKD Epidemiology Collaboration] creatinine equation23) measured between October 1, 2004, and September 30, 2006, in the national Veterans Affairs (VA) Corporate Data Warehouse LabChem data files, with follow-up until September 15, 2011 (N = 3,582,478).24 For the present study, patients were included at the first instance
Baseline Characteristics
Among the 161,185 participants who underwent an eligible major surgery during the study period, mean age was 64 years, 96.3% were men, and 16.9% were African American (Table 1). Average blood pressure in the year prior to surgery was 133/76 mm Hg, and average BMI was 29 kg/m2. Mean eGFR was 80 mL/min/1.73 m2, and 12.0% of the population had eGFRs < 60 mL/min/1.73 m2. The most common type of surgery was general (27.7%), followed by orthopedic (20.8%), vascular (16.5%), and cardiac (13.8%). Persons
Discussion
In this national study of US veterans undergoing major surgery, the overall rate of postoperative AKI was 11.8%, ranging from 4.1% after ENT surgery to 13.2% after general surgery to 18.7% after cardiac surgery. Risk factors for postoperative AKI were fairly uniform by type of surgery and consistently included African American race, higher BMI, liver disease, and lower eGFR if eGFR was <90 mL/min/1.73 m2. Higher AKI stage was associated with worse outcomes. Results were robust to different
Acknowledgements
Some aspects of this study were presented as a poster at the American Society of Nephrology Annual Kidney Week on November 13, 2014, in Philadelphia, PA.
Some of the data reported here have been supplied by the US Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.
Support: Dr Grams receives support from the National Institute of Diabetes and Digestive and
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