29 Dec Acute Kidney Injury Raises Cardiovascular Mortality in Vascular Surgery Patients
MedicalResearch.com Interview with:
Azra Bihorac, MD, MS and
Department of Anesthesiology
Charles Hobson, MD, MHA
Department of Surgery, Malcolm Randall Veterans Affairs Medical Center,
Department of Health Services Research, Management, and Policy
University of Florida Gainesville Florida
Medical Research: What is the background for this study? What are the main findings?
Response: Background is that as ICU clinicians we see acute kidney injury (AKI) and chronic kidney disease (CKD) frequently and have to deal with the consequences, and as AKI researchers we have shown that even mild and moderate AKI – even if there is complete resolution of the AKI by the time of hospital discharge – result in significantly increased morbidity and mortality for the surgical patient. Furthermore we are aware of the existing relationship between CKD and cardiovascular mortality, and we wanted to explore any relationship between AKI and cardiovascular mortality in the vascular surgery patients that we care for on a daily basis. The most important finding was the strong association between AKI and cardiovascular mortality in these patients – equal to the well-known association between CKD and cardiovascular mortality.
Medical Research: What should clinicians and patients take away from your report?
Response: There are two important implications for both clinicians and patients.
- First is the need for better prevention, treatment and follow-up for AKI before and after it happens. Our manuscript is another in a growing body on literature on the importance of even mild and moderate AKI – conditions that were not even appreciated as disease until recently.
- Second is the need for better cardiovascular follow-up for vascular surgery. This is perhaps less novel, given the well-known association between vascular and cardiac disease, but it is an important reminder for clinicians caring for these patients.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: That is an important question. We need to explore the association between cardiovascular complications and kidney disease in a more diverse surgical population. We have a study in review on this topic. There is more research needed on identifying, in real time, patients at evolving risk for AKI. For example, patients may be at low risk at the beginning of their surgical procedure, but if peri-operative complications develop the patient may be at high risk by the time he or she arrives in the ICU. Identifying such patients, and thus initiating workup and treatment for AKI in a more timely manner, may contribute to improved outcomes for these patients.
Huber M, Ozrazgat-Baslanti T, Thottakkara P, Scali S, Bihorac A, Hobson C. Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery. JAMA Surg. Published online December 23, 2015. doi:10.1001/jamasurg.2015.4526.
Azra Bihorac, MD, MS and Charles Hobson, MD, MHA (2015). Acute Kidney Injury Raises Cardiovascular Mortality in Vascular Surgery Patients