Meersch M.Weiss R.Strauß C.Albert F.Booke H.Forni L.Pittet J.2024-06-122024-06-1220240342-4642https://doi.org/10.1007/s00134-023-07314-2https://hdl.handle.net/20.500.14551/16102Purpose: 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 Disease; Acute Kidney Injury; Chronic Kidney Disease; Postoperative; SurgeryAcetylsalicylic Acid; Aminoglycoside; Angiotensin Receptor Antagonist; Beta Adrenergic Receptor Blocking Agent; Contrast Medium; Cyclosporine; Dipeptidyl Carboxypeptidase Inhibitor; Diuretic Agent; Epinephrine; Hydroxymethylglutaryl Coenzyme A Reductase Inhibitor; Hypertensive Factor; Nonsteroid Antiinflammatory Agent; Noradrenalin; Tacrolimus; Vancomycin; Acute Kidney Failure; Adult; American Society Of Anaesthesiologists Score; Article; Atrial Fibrillation; Bronchospasm; Cerebrovascular Accident; Chronic Kidney Failure; Chronic Obstructive Lung Disease; Clinical Outcome; Clinical Trial (Topic); Cohort Analysis; Comorbidity; Congestive Heart Failure; Controlled Study; Creatinine Blood Level; Death; Diabetes Mellitus; Disease Duration; Disease Exacerbation; Disease Severity; Drug Exposure; Estimated Glomerular Filtration Rate; Female; Heart Atrium Flutter; Heart Infarction; Heart Surgery; Human; Hypertension; Major Clinical Study; Major Surgery; Male; Middle Aged; Multicenter Study; Observational Study; Perioperative Period; Peripheral Vascular Disease; Pneumonia; Postoperative Care; Postoperative Complication; Prospective Study; Pulmonary Aspiration; Risk Factor; Secondary Analysis; Sepsis; Survivor; Urologic Surgery; Vascular Surgery; Acute Disease; Acute Kidney Failure; Chronic Kidney Failure; Clinical Trial; Kidney; Acute Disease; Acute Kidney Injury; Humans; Kidney; Prospective Studies; Renal Insufficiency, ChronicArticle5022472572-s2.0-8518339346738285051Q1