Meersch, M.Weiss, R.Strauß, C.Albert, F.Booke, H.Forni, L.Pittet, J.2024-08-232024-08-2320240342-4642https://doi.org/10.1007/s00134-023-07314-2https://hdl.handle.net/20.500.12684/14770Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors. © The Author(s) 2024.en10.1007/s00134-023-07314-2info:eu-repo/semantics/openAccessAcute kidney diseaseAcute kidney injuryChronic kidney diseasePostoperativeSurgeryAcute DiseaseAcute Kidney InjuryHumansKidneyProspective StudiesRenal Insufficiency, Chronicacetylsalicylic acidaminoglycosideangiotensin receptor antagonistbeta adrenergic receptor blocking agentcontrast mediumcyclosporinedipeptidyl carboxypeptidase inhibitordiuretic agentepinephrinehydroxymethylglutaryl coenzyme A reductase inhibitorhypertensive factornonsteroid antiinflammatory agentnoradrenalintacrolimusvancomycinacute kidney failureadultAmerican Society of Anaesthesiologists scoreArticleatrial fibrillationbronchospasmcerebrovascular accidentchronic kidney failurechronic obstructive lung diseaseclinical outcomeclinical trial (topic)cohort analysiscomorbiditycongestive heart failurecontrolled studycreatinine blood leveldeathdiabetes mellitusdisease durationdisease exacerbationdisease severitydrug exposureestimated glomerular filtration ratefemaleheart atrium flutterheart infarctionheart surgeryhumanhypertensionmajor clinical studymajor surgerymalemiddle agedmulticenter studyobservational studyperioperative periodperipheral vascular diseasepneumoniapostoperative carepostoperative complicationprospective studypulmonary aspirationrisk factorsecondary analysissepsissurvivorurologic surgeryvascular surgeryacute diseaseacute kidney failurechronic kidney failureclinical trialkidneyArticle502247257382850512-s2.0-85183393467Q1