Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease

Abstract Objective The association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the intermediary role of acute kidney disease (AKD), in valvular heart surgery patients. Methods We assessed the occurrence of postoperative AKI (7 days post-surgery), AKD (3 months post-surgery), and CKD (12 months post-surgery) in 1386 patients. The primary outcome was the development of AKD and CKD according to AKI occurrence. Relevant risk factors of AKI, AKD, and CKD were identified through multivariable regression analysis. Results AKI occurred in 23.9% of patients with normal preoperative renal function. Even with early recovery of renal function within 3 days, AKI increased the risk of AKD (OR 3.21, 95% CI 1.98–5.20, P Conclusions Even after early recovery, post-valvular heart surgery AKI was associated with increased risk of CKD via AKD in a graded manner related to AKI severity and persistence. Postoperative cardiac dysfunction assessed 3 months post-surgery also significantly influenced CKD development, indicating a need for close follow-up of cardiac and renal function to improve patient outcomes.