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To the Editor In a single-center cohort study of 3646 patients who underwent inpatient vascular surgery, 2000-2010, at a tertiary care teaching hospital, Huber et al1 had demonstrated that perioperative acute kidney injury (AKI) occurred in 1801 patients (49.4%). Furthermore, adjusted cardiovascular mortality estimates at 10 years were 17%, 31%, 30%, and 41%, respectively, for patients with no kidney disease, AKI without chronic kidney disease (CKD), CKD without AKI, and AKI with CKD.1 Moreover, adjusted hazard ratios (HRs) and 95% CIs for cardiovascular mortality were significantly elevated among patients with AKI without CKD (HR, 2.07 [95% CI, 1.74-2.45]), CKD without AKI (HR, 2.01 [95% CI, 1.46-2.78]), and AKI with CKD (HR, 2.99 [95% CI, 2.37-3.78]) and were higher than those for other risk factors, including increasing age (HR, 1.03 per 1-year increase [95% CI, 1.02-1.04 per 1-year increase]), and emergent surgery (HR, 1.47 [95% CI, 1.27-1.71]).1 The authors had very appropriately called for a more rigorous pursuit of preoperative and postoperative risk stratification for kidney disease and the implementation of strategies now available to help prevent perioperative AKI.
Onuigbo MAC. Perioperative Acute Kidney InjuryPrevention Rather Than Cure. JAMA Surg. 2016;151(8):782-783. doi:10.1001/jamasurg.2016.0455