• Alparslan Turan, Barak Cohen, Janet Adegboye, Natalya Makarova, Liu Liu, Edward J Mascha, Yuwei Qiu, Samuel Irefin, Brett J Wakefield, Kurt Ruetzler, and Daniel I Sessler.
• From the Departments of Outcomes Research (A.T., B.C., J.A., N.M., L.L., E.J.M., Y.Q., K.R., D.I.S.) General Anesthesia (A.T., S.I., B.J.W., K.R.) Quantitative Health Sciences (N.M., L.L., E.J.M.), Cleveland Clinic, Cleveland, Ohio the Division of Anesthesia, Critical Care and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (B.C.).
• Anesthesiology. 2020 May 1; 132 (5): 1053-1061.

BackgroundPerioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and do not experience mild kidney injury after noncardiac surgery are at similar risk for long-term renal injury.MethodsThis study is a retrospective cohort analysis of adults having noncardiac surgery at the Cleveland Clinic who had preoperative, postoperative, and long-term (1 to 2 yr after surgery) plasma creatinine measurements. The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) initiative criteria. The primary analysis was for lack of association between postoperative kidney injury (stage I vs. no injury) and long-term renal injury.ResultsAmong 15,621 patients analyzed, 3% had postoperative stage I kidney injury. Long-term renal outcomes were not similar in patients with and without postoperative stage I injury. Specifically, about 26% of patients with stage I postoperative kidney injury still had mild injury 1 to 2 yr later, and 11% had even more severe injury. A full third (37%) of patients with stage I kidney injury therefore had renal injury 1 to 2 yr after surgery. Patients with postoperative stage I injury had an estimated 2.4 times higher odds of having long-term renal dysfunction (KDIGO stage I, II, or III) compared with patients without postoperative kidney injury (odds ratio [95% CI] of 2.4 [2.0 to 3.0]) after adjustment for potential confounding factors.ConclusionsIn adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.

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