Risk factors for postoperative acute kidney injury in major non-cardiac surgery: Systematic review with meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined preoperative and intraoperative factors associated with acute kidney injury after major non-cardiac surgery. Of 533 studies identified, ten met the inclusion criteria. Diabetes, hypertension, ACE inhibitor or ARB use, ischaemic heart disease, and male sex were significantly associated with higher postoperative AKI odds. The largest reported association was for ischaemic heart disease (OR 1.93, CI 1.55-2.41). Female sex and higher preoperative haemoglobin were reported as protective factors; associations with older age, low glomerular filtration rate, longer operative time, and higher serum creatinine were not statistically significant.

Key findings

• Ischaemic heart disease was associated with higher postoperative AKI odds (OR: 1.93, CI: 1.55-2.41).
• Diabetes mellitus, hypertension, ACE inhibitor or ARB use, and male sex were also significant risk factors (ORs: 1.65, 1.86, 1.76, and 1.28, respectively).
• Female sex was associated with lower AKI odds (OR: 0.72, CI: 0.54-0.96); higher preoperative haemoglobin was also reported as protective (MD: -0.41, CI: -0.52 to -0.30).
• Older age, low glomerular filtration rate, prolonged operative time, and higher serum creatinine showed trends that were not statistically significant.

Why it matters

Postoperative AKI risk reflects a combination of patient comorbidities and medication exposure. Synthesising these associations may help inform preoperative risk assessment and highlight factors warranting attention, while the non-significant findings caution against treating all proposed predictors as established risk factors.

What to keep in mind

Only ten studies met the inclusion criteria, and the review describes heterogeneous findings across the literature; the abstract does not report further limitations.