Objective Determine the long-term cardiovascular-specific mortality in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) after major surgery. Summary Background Data In surgical patients, preexisting CKD and postoperative AKI are associated with increases in all-cause mortality. Methods In a single-center cohort of 51,457 adult surgical patients undergoing major inpatient surgery, long-term cardiovascular-specific mortality was modeled using a multivariable subdistributional hazards model while treating any other cause of death as a competing risk and accounting for the progression to end-stage renal disease (ESRD) after discharge. Preexisting CKD and ESRD and postoperative AKI were the main independent predictors. Results Prior to the admission, 4% and 8% of the cohort had preexisting ESRD and CKD not requiring renal replacement therapy, respectively. During hospitalization, 39% developed AKI. At 10-year follow-up, adjusted cardiovascular-specific mortality estimates were 6%, 11%, 12%, 19% and 27% for patients with no kidney disease, AKI with no CKD, CKD with no AKI, AKI with CKD, and ESRD, respectively (P<0.001). This association remained after excluding 916 patients who progressed to ESRD after discharge although it was significantly amplified among them. Compared to patients with no kidney disease, adjusted hazard ratios for cardiovascular mortality were significantly higher among patients with kidney disease ranging from 1.95 (95% CI, 1.80-2.11) for patients with de novo AKI to 5.70 (CI, 5.00-6.49) for patients with preexisting ESRD. Conclusions Both acute kidney injury and chronic kidney disease were associated with higher long-term cardiovascular-specific mortality compared to patients with no kidney disease.
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