Administering acetaminophen within the first 48 hours after cardiac surgery reduces the risk of severe acute kidney injury (AKI), new study findings suggest.

Investigators examined the risk of postoperative AKI in 2 adult cohorts: the Medical Information Mart for Intensive Care (MIMIC)-III and the eICU Collaborative Research Database (eICU) registries. Among 5791 patients in MIMIC-III and 3840 patients in eICU, stage 2-3 AKI within 7 days of surgery occurred in 58% and 37%, respectively. Acetaminophen was administered to 72% and 71% of patients of the respective cohorts within 48 hours after cardiac surgery.

Severe AKI after cardiac surgery occurred in a significantly lower proportion of patients who received early acetaminophen than those who did not in both the MIMIC-III cohort (52% vs 75%) and the eICU cohort (36.0% vs 40.3%). In adjusted analyses, early acetaminophen use was significantly associated with a 14% and 16% lower risk of severe AKI in MIMIC-III and eICU, Fuxia Yan, MD, of Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China, and colleagues reported in the American Journal of Kidney Diseases. Results were consistent for patients with and without chronic kidney disease, by type of cardiac surgery (coronary artery bypass graft surgery and/or valve-related surgery), and by Sequential Organ Failure Assessment (SOFA) score.

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Acetaminophen use also was independently associated with 52% and 23% decreased odds of developing AKI of any stage in both MIMIC-III and eICU cohort, respectively. It was not associated with the risk of renal replacement therapy or in-hospital death.

Among the study’s limitations, acetaminophen indication, dosing, and adverse effects were unknown. The investigators also had no information on prescription of opioids and non-steroidal anti-inflammatory drugs, both of which increase AKI risk.

“Our results are largely consistent with experimental results and limited clinical data, and suggest that a trial of acetaminophen for prevention of kidney injury is indicated, Dr Yan’s team concluded.


Xiong C, Jia Y, Wu X, Yuan S, Yan F, Sessler DI. Early postoperative acetaminophen administration and severe acute kidney injury after cardiac surgery. Am J Kid Dis. Published online December 28, 2022. doi:10.1053/j.ajkd.2022.11.009