Postoperative acute kidney injury (AKI) is an independent risk factor for progression of chronic kidney disease (CKD), according to a recent study.

Patients with preoperative CKD who experienced postoperative AKI stages 1, 2, and 3 had an approximately 5.9-, 3.9-, and 3.6-fold increased risk for CKD progression, respectively, within 1 year following surgery compared with patients who did not have AKI, Jamie R. Privratsky, MD, PhD, of Duke University Medical Center in Durham, North Carolina, and colleagues reported in Anesthesia & Analgesia. Increasing AKI severity, however, was not associated with additional risk, they reported.

The investigators adjusted for baseline estimated glomerular filtration rate (eGFR) and CKD stage.

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The retrospective study included 5548 patients with CKD in Iceland. None of the patients had CKD stage 5, underwent major urologic procedures, or had missing creatinine values for follow-up eGFR stage.

“Our study has implications for perioperative care and risk assessment as it demonstrates the importance of close monitoring of kidney function both before and after surgery along with providing rationale to further study whether AKI biomarkers can better differentiate patients that are likely to have kidney disease progression after surgery,” the investigators concluded.

The study’s primary outcome was time to progression by at least 1 eGFR/CKD stage within 1 year following surgery. The investigators defined AKI stage using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.


Privratsky JR, Krishnamoorthy V, Raghunathan K, et al. Postsoperative acute kidney injury is associated with progression of chronic kidney disease independent of severity. Anesth Analg. 2022;134:49-58. doi:10.1213/ANE.0000000000005702