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Comment & Response |

Perioperative Acute Kidney Injury Prevention Rather Than Cure

Macaulay Amechi Chukwukadibia Onuigbo, MD, MSc, FWACP, MBA1,2
[+] 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.
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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.


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August 1, 2016
Charles Hobson, MD, MHA; Matthew Huber, BS; Azra Bihorac, MD, MS
1Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida2Department of Health Services Research, Management, and Policy, University of Florida, Gainesville
3Department of Anesthesiology, University of Florida, Gainesville
JAMA Surg. 2016;151(8):783. doi:10.1001/jamasurg.2016.0470.
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