Acute kidney injury after cardiac surgery is associated with mid-term but not long-term mortality: A cohort-based study

Alejandro Ferreiro, Raúl Lombardi, Alejandro Ferreiro, Raúl Lombardi

Abstract

Acute kidney injury (AKI) in cardiac surgery is associated with complications, early and late mortality and increased health care expenditures. The overall dynamic comorbidity-adjusted contributions of an episode of AKI on mortality during long-term follow-up have not been fully explored. A longitudinal cohort of 7075 adult patients admitted for cardiac surgery were enrolled in the study. Follow-up data were obtained through telephonic survey after 1, 5, 10, and 15 years or from the National Mortality Registry. All-cause mortality was assessed at five time intervals: I) 30 days after surgery to 1 year; II) 1 to 3 years; III) 3 to 5 years; IV) 5 to 10 years; and V) 10 to 15 years. For the adjustment of mortality for comorbidity and pre-, intra- and postoperative variables, Cox proportional hazard regression models were conducted within each period. The overall incidence of AKI was 36.1%. AKI was an independent predictor of death only during the first five years after surgery (30 days to 1 year: HR 1.834, 95% CI 1.459 to 2.306; 1 to 3 years: HR 1.285, 95% CI 1.023 to 1.610; and 3 to five years: HR 1.330, 95% CI 1.123 to 1.750). Only age, diabetes mellitus and CHF were associated with increased risk of death over the entire follow-up period. Our study demonstrates a transient association of AKI with long-term mortality that progressively decreases and vanishes five years after surgery. The knowledge of this dynamic is crucial to understanding this complex association, planning health care and allocating resources.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Kaplan-Meier cumulative survival curve from…
Fig 1. Kaplan-Meier cumulative survival curve from 30 days after surgery to 15 years follow-up.
(Blue: patients without AKI, Green: patients who developed AKI). p

Fig 2. Kaplan-Meier cumulative survival curves from…

Fig 2. Kaplan-Meier cumulative survival curves from 30 days after surgery to 15 years follow-up.

Fig 2. Kaplan-Meier cumulative survival curves from 30 days after surgery to 15 years follow-up.
(Blue: patients without AKI; Green: patients who developed AKI stage I; Yellow: patients who developed AKI stage II; Purple: patients who developed AKI stage III); p
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Fig 2. Kaplan-Meier cumulative survival curves from…
Fig 2. Kaplan-Meier cumulative survival curves from 30 days after surgery to 15 years follow-up.
(Blue: patients without AKI; Green: patients who developed AKI stage I; Yellow: patients who developed AKI stage II; Purple: patients who developed AKI stage III); p

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