(123) Predictors of post-operative acute kidney injury after colorectal cancer surgery

Background: Post-operative acute kidney injury (PO-AKI) is a common complication following colorectal cancer (CRC) surgery. PO-AKI is associated with increased morbidity and mortality, and higher hospital costs. Specific treatment of AKI is still limited, supporting the importance of preventing AKI. Identification of patients at high risk may allow early interventions, closer monitoring and perioperative optimization.

Objectives: This study aimed to assess the association between patient characteristics known preoperatively and the occurrence of PO-AKI.

Methods: We conducted a nationwide cohort study including patients undergoing primary surgery for stage I-IV CRC in 2010–2021 using Danish health registries. We defined PO-AKI as AKI within 7 days after CRC surgery based on the 2012 Kidney Disease: Improving Global Outcomes criteria using creatinine measurements. Patient characteristics associated with AKI were identified from existing literature. The selected patient characteristics, diagnostic codes, redeemed prescriptions, and laboratory data were obtained using population-based health registries. Patients with missing information or no creatinine measurement in the year prior to operation were excluded. We investigated the individual characteristics by estimating PO-AKI risks and calculating adjusted odds ratios (aORs) with 95% confidence intervals, adjusting for sex and age.

Results: We identified 44,117 CRC patients, of whom 34,257 were eligible for further analysis. Among these patients, we identified 3,066 patients with PO-AKI, corresponding to a 8.9% risk of PO-AKI.
The risk of PO-AKI was higher for males (10.4% vs. 7.2%, aOR = 1.57 [1.46-1.70]), and patients with diabetes mellitus (13.0 % vs. 8.4%, aOR = 1.49 [1.35-1.65]), heart failure (16.3% vs. 8.8%, aOR = 1.65 [1.34-2.01]), CKD (15.4% vs. 7.6%, aOR = 1.86 [1.70-2.04]), COPD (13.6% vs. 8.8%, aOR = 1.47 [1.24-1.72]), and hypertension (12.0% vs. 8.1%, aOR = 1.38 [1.27-1.50]).
When examining potentially nephrotoxic medications, the risk was higher in users of Angiotensin-converting-enzyme inhibitors (ACE-I) or Angiotensin II receptor blockers (ARB) (11.7% vs. 8.1%, aOR = 1.37 [1.26-1.48]), users of diuretics (15.1% vs. 8.5%, aOR = 1.67 [1.48-1.88]) and similar in NSAID users and nonusers (8.1% vs. 9.0%, aOR = 0.96 [0.81-1.12]).

Conclusions: We found that male sex, diabetes mellitus, cardiovascular disease, CKD, COPD, hypertension, and the use of ACE-I/ARB medications were associated with a higher risk of PO-AKI. Interestingly, users and nonusers of NSAIDs had similar risks of AKI. The identification of high-risk groups, such as those with pre-existing comorbidities or users of specific medications, may aid clinicians in individually optimized monitoring.