Acute kidney injury and 1-year mortality after colorectal cancer surgery: a population-based cohort study

• Published in: BMJ open Vol. 9; no. 3; p. e024817
• Main Authors: Slagelse, Charlotte, Gammelager, Henrik, Iversen, Lene Hjerrild, Sørensen, Henrik Toft, Christiansen, Christian F
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13-03-2019; BMJ Publishing Group
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Cancer surgery; Cancer therapies; Cohort analysis; Colorectal cancer; Colorectal Neoplasms - surgery; Creatinine - blood; Demographics; Denmark - epidemiology; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Digestive System Surgical Procedures - mortality; Epidemiology; Female; Hospitals; Humans; Information systems; Kidney diseases; Laboratories; Long Term Adverse Effects - etiology; Long Term Adverse Effects - mortality; Male; Middle Aged; Mortality; Patients; Population; Population-based studies; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - therapy; Renal Replacement Therapy - methods; Renal Replacement Therapy - statistics & numerical data; Surgery; Urine; Denmark; Europe; mortality; postoperative complications; colorectal surgery; acute kidney injury; colorectal neoplasms
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-024817

ObjectivesAcute kidney injury (AKI) is a frequent postoperative complication, but the mortality impact within different postoperative time frames and severities of AKI are poorly understood. We examined the occurrence of postoperative AKI among colorectal cancer (CRC) surgery patients and the impact of AKI on mortality during 1 year after surgery.DesignObservational cohort study. We defined the exposure, AKI, as a 50% increase in plasma creatinine or initiation of renal replacement therapy within 7 days after surgery or an absolute increase in creatinine of 26 µmol/L within 48 hours.SettingPopulation-based Danish medical databases.ParticipantsA total of 6580 patients undergoing CRC surgery in Northern Denmark during 2005–2011 were included from the Danish Colorectal Cancer Group database.Outcomes measureOccurrence of AKI and 8–30, 31–90 and 91–365 days mortality in patient with or without AKI.ResultsAKI occurred in 1337 patients (20.3%) of the 6580 patients who underwent CRC surgery. Among patients with AKI, 8–30, 31–90 and 91–365 days mortality rates were 10.1% (95% CI 8.6% to 11.9%), 7.8% (95% CI 6.4% to 9.5%) and 12.0% (95% CI 10.3% to 14.2%), respectively. Compared with patients without AKI, AKI was associated with increased 8–30 days mortality (adjusted HR (aHR)=4.01,95% CI 3.11 to 5.17) and 31–90 days mortality (aHR 2.08,95% CI 1.60 to 2.69), while 91–365 days aHR was 1.12 (95% CI 0.89 to 1.41). We observed no major differences in stratified analyses.ConclusionsAKI after surgery for CRC is a frequent postoperative complication associated with a substantially increased 90-day mortality. AKI should be considered a potential target for reducing 90-day mortality.