Abstract: Objective To investigate the incidence of acute kidney injury(AKI) after noncardiac surgery and evaluate the risk factors of postoperative AKI using a nested case-control design. Methods We conducted a retrospective study of 19 132 patients who underwent noncardiac surgery from Jan 2012 to Oct 2014, among which 28 cases could be diagnosed with AKI which occurred postoperatively. 168 cases with similar surgical types, date of operation and anesthesia technique were explored as control group according to the principle of the nested case-control design. Postoperative AKI was defined by serum creatinine change, as per the kidney disease improving global outcomes(KDIGO) guideline. The possible risk factors for postoperative AKI were evaluated including age, sex, BMI, hypertension, diabetes, preoperative use of angiotensin converting enzyme inhibitors(ACEI) or angiotensin receptor blockers(ARB), hypoalbuminemia and intraoperative hypotension. Results Of the 19 132 patients, 28(0.146%) developed AKI. Among the 28 cases, 14(50%) cases were gastrointestinal surgery, 6(22%) cases were abdominal organs surgery, 2(7%) cases were gynecological surgery, 2(7%) cases were urology surgery, 2(7%) cases were orthopaedic surgery, and 2(7%) cases were other surgery. 15 cases were emergency in total. Univariate analysis showed that hypertension, hypoalbuminemia, preoperative use of ACEI or ARB, intraoperative hypotension, blood transfusion and emergency surgery were possibly relative to postoperative AKI(P<0.05). Logistic regression analysis further revealed that intraoperative hypotension, preoperative use of ACEI or ARB, hypoalbuminemia and emergency surgery were risk factors for AKI after noncardiac surgery. Conclusions AKI is not uncommon after noncardiac surgery. The surgeries that tend to develop AKI are those which have interrupted the haemodynamics and influenced the homeostasis of the patients. Intraoperative hypotension, preoperative use of ACEI or ARB, hypoalbuminemia and emergency surgery are independent predictors for AKI after noncardiac surgery.
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