Acute kidney injury and 1-year mortality after colorectal cancer surgery: a population-based cohort study

Abstract

ObjectivesAcute kidney injury (AKI) is a frequent postoperative complication, but the mortality impact within different postoperative time frames and severities of AKI are poorly understood. We examined the occurrence of postoperative AKI among colorectal cancer (CRC) surgery patients and the impact of AKI on mortality during 1 year after surgery.DesignObservational cohort study. We defined the exposure, AKI, as a 50% increase in plasma creatinine or initiation of renal replacement therapy within 7 days after surgery or an absolute increase in creatinine of 26 µmol/L within 48 hours.SettingPopulation-based Danish medical databases.ParticipantsA total of 6580 patients undergoing CRC surgery in Northern Denmark during 2005–2011 were included from the Danish Colorectal Cancer Group database.Outcomes measureOccurrence of AKI and 8–30, 31–90 and 91–365 days mortality in patient with or without AKI.ResultsAKI occurred in 1337 patients (20.3%) of the 6580 patients who underwent CRC surgery. Among patients with AKI, 8–30, 31–90 and 91–365 days mortality rates were 10.1% (95% CI 8.6% to 11.9%), 7.8% (95% CI 6.4% to 9.5%) and 12.0% (95% CI 10.3% to 14.2%), respectively. Compared with patients without AKI, AKI was associated with increased 8–30 days mortality (adjusted HR (aHR)=4.01,95% CI 3.11 to 5.17) and 31–90 days mortality (aHR 2.08,95% CI 1.60 to 2.69), while 91–365 days aHR was 1.12 (95% CI 0.89 to 1.41). We observed no major differences in stratified analyses.ConclusionsAKI after surgery for CRC is a frequent postoperative complication associated with a substantially increased 90-day mortality. AKI should be considered a potential target for reducing 90-day mortality.

<p>The Effect of Admission Serum Magnesium on the Acute Kidney Injury Among Patients with Malignancy</p>

“…Acute kidney injury (AKI) is an important factor affecting the prognosis of patients with cancer, [5][6][7] which greatly related to morbidity and mortality. 8 The risk of AKI among cancer patients was significantly higher than that of patients without malignancy.…”

L-Arginine/NO Pathway Metabolites in Colorectal Cancer: Relevance as Disease Biomarkers and Predictors of Adverse Clinical Outcomes Following Surgery

“…The pool of dimethylarginines is regulated by the rate of their synthesis as well as degradation, which includes renal excretion and enzymatic degradation to citrulline and DMA in the case of ADMA but solely renal excretion in the case of SDMA [ 11 ]. The anesthesia during surgery, blood loss, surgery-induced increase in aldosterone and antidiuretic hormone, and electrolyte imbalance associated with bowel manipulation and postoperative ileus may impair the renal function [ 48 , 49 ]. It is possible that such altered filtration in the early postoperative period hampers SDMA excretion, leading to metabolite accumulation in the blood.…”

Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

“…With the ageing population, the frequency of ACE-I/ARB use and the number of CRC surgeries are expected to rise. Around 20% of patients undergoing CRC surgery develop AKI within 7 days after the surgery,5 and of these, approximately 30% are either under current or former treatment with ACE-I/ARB. Moreover, 25% of the patients who are current or former users develop AKI after CRC surgery.…”

“…Unfortunately, they may increase the risk of acute kidney injury (AKI) through their inhibition of angiotensin II leading to renal vasodilatation and consequently decreased glomerular filtration rate (GFR) 4. AKI is defined as a sudden decline in the excretory function of the kidneys and occurs in around 20% of patients undergoing colorectal cancer (CRC) surgery 5. AKI may arise as a result of prerenal, intrarenal or postrenal causes, as well as a combination of these.…”