Background and Goal of Study: Several studies showed that acute kidney injury (AKI) is associated  with chronic kidney disease (CKD) after cardiac surgery1). However, there are no studies investigating the association between AKI and CKD after major abdominal surgery. In addition, recent investigations suggested that patients with cancer develop CKD after AKI2). The aim of this study was of to determine the association between CKD and AKI in cancer patients after major abdominal surgery. To this end, we retrospectively studied non-CKD patients who underwent major abdominal surgery and developed AKI after surgery Materials and Methods: A total of 478 patients who underwent major abdominal surgery (excluding renal and urological surgery) between 2013 and 2015 were followed for 2 years. AKI was defined as KDIGO classification and CKD was defined using guidelines of Japan Society of Nephrology. Cox regression analysis and multivariate logistic analysis were performed for abdominal surgery with cancer and non-cancer patients by matching propensity scores. The propensity score for abdominal surgery for cancer was estimated using age, preoperative eGFR and AKI covariates. Results and Discussion:A total of 101 patients developed CKD (21%). AKI was associated 26 patients (36%, p=0.002) and cancer surgery was included 70 patients (69%, p=0.003). Matching was possible for 110 cases. During the 2-years follow-up, 11 cases (20%) developed CKD after cancer surgery as opposed to 2 cases (3.6%) in non-cancer surgery ( hazard ratio: 4.9; 95% CI: 1.3 to 31.6; p=0.016). On the other hand, 6 cases (46%) developed AKI as opposed to 13 cases (8.1%) in the non-AKI group (hazard ratio: 4.7; 95% CI: 1.5 to 14.2, p=0.009). Multivariate logistic analysis showed that AKI and cancer surgery are risk factors for CKD (AKI: odds ratio: 6.6, 95% CI 1.3 to 39.4, p=0.025; cancer surgery: odds ratio: 8.8, 95% CI: 1.6 to 81.5, p=0.009). These results indicate that the risk of CKD in cancer patients who undergo major abdominal surgery and have AKI during the perioperative period is higher than in non-cancer patients without AKI.
Conclusion(s): This study shows that cancer and AKI are independent risk factors for CKD after major
abdominal surgery.
References (optional): 1) Legouis D et al: Anesthesiology; 2017,126:39-46
2) Lameire N et al: Critical Care; 2016; 20:209-220

05 / Cancer and acute kidney injury are independent risk factors of postoperative kidney disease after major abdominal surgery