Acute kidney injury after major elective surgery more common than ever before: study

25/06/2012

The number of patients receiving acute dialysis after cardiac and vascular surgery has increased threefold since 1995. In a new study, researchers at the Institute for Clinical Evaluative Sciences (ICES) and the Lawson Health Research Institute in London, Ontario show a significant increase in the complications of severe acute kidney injury (AKI) requiring dialysis after major elective surgery.

“Outcomes of patients treated with acute dialysis after surgery remain poor. Our results should prompt renewed efforts to develop and test interventions to prevent severe acute kidney injury and to lessen the high burden of death and end-stage renal disease after acute kidney injury has occurred,” says Dr. Amit Garg, one of the lead authors on the study. Dr. Garg is a scientist at the Lawson Health Research Institute and ICES, a kidney specialist at the London Health Sciences Centre, and a Professor of Medicine and Epidemiology at Western University.

The population-based study of Ontario patients between 1995 and 2009 found:

552,672 patients underwent major elective surgery and 2,231 received acute dialysis.
AKI requiring dialysis is a devastating complication of major elective surgery.
Among patients who received acute dialysis, 937 died within 90 days of surgery.
Among the 1,294 patients who received acute dialysis and survived, 352 required chronic dialysis.
The incidence of acute dialysis increased from 0.2 per cent in 1995 to 0.6 per cent in 2009.
This increase was primarily seen following cardiac and vascular surgeries.

"The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Interventional studies to better prevent and treat peri-operative acute kidney injury are needed,” says Dr. Nausheen Siddiqui, co-author of the study.“

Secular trends in acute dialysis following surgery, 1995 to 2009” is being published in the June 25, 2012 issue of the CMAJ.

Authors: Siddiqui N., Coca S., Devereaux PJ., Jain A., Li L, Luo J., Parikh C., Paterson M., Thiessen-Philbrook H., Wald R., Walsh M., Whitlock R., Garg AX.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

Lawson Health Research Institute. As the research institute of London Health Sciences Centre and St. Joseph's Healthcare, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance healthcare around the world. www.lawsonresearch.com This work was done by the new provincial ICES Kidney, Dialysis and Transplantation Research Program.