• Mårten Renberg, Daniel Hertzberg, Claire Rimes-Stigare, Linn Hallqvist, and Max Bell.
• Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. Electronic address: marten.renberg@regionstockholm.se.
• Br J Anaesth. 2024 Mar 28.

BackgroundLimited knowledge exists regarding long-term renal outcomes after noncardiac surgery. This study investigated the incidence of, and risk factors for, developing advanced chronic kidney disease (CKD) and major adverse kidney events within 1 yr of surgery in a nationwide cohort.MethodsAdults without renal dysfunction before noncardiac surgery in Sweden were included between 2007 and 2013 in this observational multicentre cohort study. We analysed data from a national surgical database linked to several national and quality outcome registries. Associations of perioperative risk factors with advanced CKD (estimated glomerular filtration rate [eGFR] <30 ml min-1 1.73 m-2) and major adverse kidney events within 1 yr (MAKE365, comprising eGFR <30 ml min-1 1.73 m-2, chronic dialysis, death) were quantified.ResultsOf 237,124 patients, 1597 (0.67%) developed advanced CKD and 16,789 (7.1%) developed MAKE365. Risk factors for advanced CKD included higher ASA physical status, urological surgery, extended surgical duration, prolonged postoperative hospital stay, repeated surgery, and postoperative use of renin-angiotensin-aldosterone system blockers. Advanced acute kidney disease (AKD) (eGFR <30 ml min-1 1.73 m-2 within 90 postoperative days) occurred in 1661 (0.70%) patients and was associated with advanced CKD (subdistribution hazard ratio [SHR] 44.5, 95% confidence interval [CI] 38.7-51.1) and MAKE365 (hazard ratio [HR] 6.60, 95% CI 6.07-7.17). Among patients with advanced AKD after surgery 36% developed advanced CKD at 1 yr after surgery and 51% developed MAKE365.ConclusionsAdvanced CKD within 1 yr after surgery is uncommon but clinically important in patients without preoperative renal dysfunction. Advanced AKD after surgery constitutes a major risk factor for advanced CKD and MAKE365.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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