Acute kidney injury and 1-year mortality after colorectal cancer surgery: a population-based cohort study

ObjectivesAcute kidney injury (AKI) is a frequent postoperative complication, but the mortality impact within different postoperative time frames and severities of AKI are poorly understood. We examined the occurrence of postoperative AKI among colorectal cancer (CRC) surgery patients and the impact of AKI on mortality during 1 year after surgery.DesignObservational cohort study. We defined the exposure, AKI, as a 50% increase in plasma creatinine or initiation of renal replacement therapy within 7 days after surgery or an absolute increase in creatinine of 26 µmol/L within 48 hours.SettingPopulation-based Danish medical databases.ParticipantsA total of 6580 patients undergoing CRC surgery in Northern Denmark during 2005–2011 were included from the Danish Colorectal Cancer Group database.Outcomes measureOccurrence of AKI and 8–30, 31–90 and 91–365 days mortality in patient with or without AKI.ResultsAKI occurred in 1337 patients (20.3%) of the 6580 patients who underwent CRC surgery. Among patients with AKI, 8–30, 31–90 and 91–365 days mortality rates were 10.1% (95% CI 8.6% to 11.9%), 7.8% (95% CI 6.4% to 9.5%) and 12.0% (95% CI 10.3% to 14.2%), respectively. Compared with patients without AKI, AKI was associated with increased 8–30 days mortality (adjusted HR (aHR)=4.01,95% CI 3.11 to 5.17) and 31–90 days mortality (aHR 2.08,95% CI 1.60 to 2.69), while 91–365 days aHR was 1.12 (95% CI 0.89 to 1.41). We observed no major differences in stratified analyses.ConclusionsAKI after surgery for CRC is a frequent postoperative complication associated with a substantially increased 90-day mortality. AKI should be considered a potential target for reducing 90-day mortality.

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Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-032964 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032964

Author(s):

Charlotte Slagelse ◽

H Gammelager ◽

Lene Hjerrild Iversen ◽

Kathleen D Liu ◽

Henrik T Toft Sørensen ◽

...

Keyword(s):

Colorectal Cancer ◽

Acute Kidney Injury ◽

Cohort Study ◽

Angiotensin Receptor Blockers ◽

Kidney Injury ◽

Population Based ◽

Adjusted Risk ◽

Increased Risk ◽

The Impact ◽

Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

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The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2014-000036 ◽

2014 ◽

Vol 1 (1) ◽

pp. e000036 ◽

Cited By ~ 10

Author(s):

Anna Maria Platon ◽

Rune Erichsen ◽

Christian Fynbo Christiansen ◽

Lea Kjær Andersen ◽

Claus Sværke ◽

...

Keyword(s):

Colorectal Cancer ◽

Chronic Obstructive Pulmonary Disease ◽

Intensive Care Unit ◽

Cohort Study ◽

Population Based ◽

Chronic Obstructive ◽

Danish Population ◽

Colorectal Cancer Surgery ◽

Obstructive Pulmonary Disease ◽

The Impact

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Preadmission kidney function and risk of acute kidney injury in patients hospitalized with acute pyelonephritis: A Danish population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0247687 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247687

Author(s):

Henriette Vendelbo Graversen ◽

Mette Nørgaard ◽

Dorothea Nitsch ◽

Christian Fynbo Christiansen

Keyword(s):

Acute Kidney Injury ◽

Risk Factor ◽

Cohort Study ◽

Kidney Function ◽

Acute Pyelonephritis ◽

Laboratory Data ◽

Kidney Injury ◽

Population Based ◽

The Impact ◽

First Time

Background and objectives Only few smaller studies have examined if impaired kidney function increases the risk of acute kidney injury in patients with acute pyelonephritis. Therefore, we estimated 30-day risk of acute kidney injury by preadmission kidney function in patients with acute pyelonephritis. Furthermore, we examined if impaired kidney function was a risk factor for development of acute kidney injury in pyelonephritis patients. Methods This cohort study included patients with a first-time hospitalization with pyelonephritis from 2000 to 2017. Preadmission kidney function (estimated glomerular filtration rate (eGFR) <30, 30–44, 45–59, 60–89, and ≥90 ml/min/1.73 m2) and acute kidney injury within 30 days after admission were assessed using laboratory data on serum creatinine. The absolute 30-days risk of acute kidney injury was assessed treating death as a competing risk. The impact of eGFR on the odds of acute kidney injury was compared by odds ratios (ORs) with 95% confidence intervals estimated using logistic regression adjusted for potential confounding factors. Results Among 8,760 patients with available data on preadmission kidney function, 25.8% had a preadmission eGFR <60. The 30-day risk of acute kidney injury was 16% among patients with preadmission eGFR ≥90 and increased to 22%, 33%, 42%, and 47% for patients with preadmission eGFR of 60–89, 45–59, 30–44, and <30 respectively. Compared with eGFR≥90, the adjusted ORs for the subgroups with eGFR 60–89, 45–59, 30–45, and <30 were 0.95, 1.32, 1.78, and 2.19 respectively. Conclusion Acute kidney injury is a common complication in patients hospitalized with acute pyelonephritis. Preadmission impaired kidney function is a strong risk factor for development of acute kidney injury in pyelonephritis patients and more attention should be raised in prevention of pyelonephritis in patients with a low kidney function.

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FO067ACUTE KIDNEY INJURY AND 1-YEAR MORTALITY AFTER COLORECTAL CANCER SURGERY:A POPULATION-BASED COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fo067 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i47-i47

Author(s):

Charlotte Slagelse ◽

Henrik Gammelager ◽

Lene Iversen ◽

Henrik Soerensen ◽

Christian Christiansen

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Kidney Injury ◽

Population Based

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Defining Baseline Creatinine for Identification of Acute Kidney Injury in Population-based Laboratory Databases - A Danish Nationwide Cohort Study

Kidney360 ◽

10.34067/kid.0006082021 ◽

2021 ◽

pp. 10.34067/KID.0006082021

Author(s):

Henriette V. Graversen ◽

Simon K. Jensen ◽

Søren V. Vestergaard ◽

Uffe Heide-Jorgensen ◽

Christian F. Christiansen

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Creatinine Level ◽

Kidney Injury ◽

Population Based ◽

Kaplan Meier ◽

All Cause Mortality ◽

Baseline Creatinine ◽

Creatinine Measurement

Background: The baseline creatinine level is central in the KDIGO criteria of acute kidney injury (AKI), but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. Methods: This nationwide cohort study included all individuals aged ≥18 in Denmark with a creatinine measurement in year 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-8 days before, or median value 90-8 days before if available otherwise median value 365-91 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity was described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. Results: The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1,000 person-years, and 30-day all-cause mortality was 17-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1,000 person-years, and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. Conclusions: In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, while the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, in particular in studies of community-acquired AKI.

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Recurrent acute kidney injury: predictors and impact in a large population-based cohort

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz155 ◽

2019 ◽

Vol 35 (8) ◽

pp. 1361-1369 ◽

Cited By ~ 6

Author(s):

Jennifer Holmes ◽

John Geen ◽

John D Williams ◽

Aled O Phillips

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Patient Outcomes ◽

Large Population ◽

Kidney Injury ◽

Population Based ◽

First Episode ◽

Single Episode ◽

Subsequent Episode ◽

The Impact

Abstract Background This study examined the impact of recurrent episodes of acute kidney injury (AKI) on patient outcomes. Methods The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients ≥18 years of age between April 2015 and September 2018. Patients were grouped according to the number of AKI episodes they experienced with each patient’s first episode described as their index episode. We compared the demography and patient outcomes of those patients with a single AKI episode with those patients with multiple AKI episodes. Analysis included 153 776 AKI episodes in 111 528 patients. Results Of those who experienced AKI and survived their index episode, 29.3% experienced a second episode, 9.9% a third episode and 4.0% experienced fourth or more episodes. Thirty-day mortality for those patients with multiple episodes of AKI was significantly higher than for those patients with a single episode (31.3% versus 24.9%, P < 0.001). Following a single episode, recovery to baseline renal function at 30 days was achieved in 83.6% of patients and was significantly higher than for patients who had repeated episodes (77.8%, P < 0.001). For surviving patients, non-recovery of renal function following any AKI episode was significantly associated with a higher probability of a further AKI episode (33.4% versus 41.0%, P < 0.001). Furthermore, with each episode of AKI the likelihood of a subsequent episode also increased (31.0% versus 43.2% versus 51.2% versus 51.7% following a first, second, third and fourth episode, P < 0.001 for all comparisons). Conclusions The results of this study provide an important contribution to the debate regarding the need for risk stratification for recurrent AKI. The data suggest that such a tool would be useful given the poor patient and renal outcomes associated with recurrent AKI episodes as highlighted by this study.

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