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Comment & Response
August 2016

Perioperative Acute Kidney Injury: Prevention Rather Than Cure

Author Affiliations
  • 1Mayo Clinic College of Medicine, Rochester, Minnesota
  • 2Department of Nephrology, Mayo Clinic Health System, Eau Claire, Wisconsin
JAMA Surg. 2016;151(8):782-783. doi:10.1001/jamasurg.2016.0455

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.

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