Perioperative Medicine  |   January 2017
Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine, Pôle Réanimations Anesthésie SAMU (D.L., J.-L.H.), and Department of Cardiac Surgery (D.B.), Caen University Hospital, Caen, France; Department of Renal Intensive Care Unit and Kidney Transplantation, AP-HP, Tenon University Hospital, Paris, France (P.G., A.H.); UPMC Sorbonne Université Paris 06, UMR S 1155, Paris, France (P.G., A.H.); Department of Biostatistics, AP-HP, Saint-Louis University Hospital, Paris, France (S.C.); Departments of Anesthesiology (S.P.) and Biochemistry (A. Boutten), APHP, Bichat Hospital, Paris, France; Department of Anesthesiology and Critical Care, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France (J.-L.F.); and French National Institute of Health and Medical Research (INSERM), UMR_S1155, Rare and Common Kidney Diseases, Matrix Remodelling and Repair department, Tenon Hospital, Paris, France (P.G., A. Bataille, A.H.).
  • Submitted for publication April 5, 2016. Accepted for publication September 6, 2016.
    Submitted for publication April 5, 2016. Accepted for publication September 6, 2016.×
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
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Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   January 2017
Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery
Anesthesiology 1 2017, Vol.126, 39-46. doi:10.1097/ALN.0000000000001400
Anesthesiology 1 2017, Vol.126, 39-46. doi:10.1097/ALN.0000000000001400
Abstract

Background: There is recent evidence to show that patients suffering from acute kidney injury are at increased risk of developing chronic kidney disease despite the fact that surviving tubular epithelial cells have the capacity to fully regenerate renal tubules and restore renal function within days or weeks. The aim of the study was to investigate the impact of acute kidney injury on de novo chronic kidney disease.

Methods: The authors conducted a retrospective population-based cohort study of patients initially free from chronic kidney disease who were scheduled for elective cardiac surgery with cardiopulmonary bypass and who developed an episode of acute kidney injury from which they recovered. The study was conducted at two French university hospitals between 2005 and 2015. These individuals were matched with patients without acute kidney injury according to a propensity score for developing acute kidney injury.

Results: Among the 4,791 patients meeting the authors’ inclusion criteria, 1,375 (29%) developed acute kidney injury and 685 fully recovered. Propensity score matching was used to balance the distribution of covariates between acute kidney injury and non- acute kidney injury control patients. Matching was possible for 597 cases. During follow-up, 34 (5.7%) had reached a diagnosis of chronic kidney disease as opposed to 17 (2.8%) in the control population (hazard ratio, 2.3; bootstrapping 95% CI, 1.9 to 2.6).

Conclusions: The authors’ data consolidate the recent paradigm shift, reporting acute kidney injury as a strong risk factor for the rapid development of chronic kidney disease.