VIN-CENT WUTAO-MIN HUANGCHUN-FU LAIChih-Chung ShiaoYU-FENG LINTZONG-SHINN CHUPei-Chen WuCHIA-TER CHAOJANN-YUAN WANGTze-Wah KaoGuang-Huar YoungPi-Ru TsaiHUNG-BIN TSAIChieh-Li WangMing-Shou WuWEN-CHIH CHIANGI-JUNG TSAIFu-Chang HuSHUEI-LIONG LINYUNG-MING CHENTUN-JUN TSAIWen-Je KoKWAN-DUN WU2020-08-132020-08-1320110085-2538https://www.scopus.com/inward/record.uri?eid=2-s2.0-81155150125&doi=10.1038%2fki.2011.259&partnerID=40&md5=dc06cf6585a6f93c8394d0a34babe846https://scholars.lib.ntu.edu.tw/handle/123456789/512501Existing chronic kidney disease (CKD) is among the most potent predictors of postoperative acute kidney injury (AKI). Here we quantified this risk in a multicenter, observational study of 9425 patients who survived to hospital discharge after major surgery. CKD was defined as a baseline estimated glomerular filtration rate <45 ml/min per 1.73 m2. AKI was stratified according to the maximum simplified RIFLE classification at hospitalization and unresolved AKI defined as a persistent increase in serum creatinine of more than half above the baseline or the need for dialysis at discharge. A Cox proportional hazard model showed that patients with AKI-on-CKD during hospitalization had significantly worse long-term survival over a median follow-up of 4.8 years (hazard ratio, 3.3) than patients with AKI but without CKD. The incidence of long-term dialysis was 22.4 and 0.17 per 100 person-years among patients with and without existing CKD, respectively. The adjusted hazard ratio for long-term dialysis in patients with AKI-on-CKD was 19.8 compared to patients who developed AKI without existing CKD. Furthermore, AKI-on-CKD but without kidney recovery at discharge had a worse outcome (hazard ratios of 4.6 and 213, respectively) for mortality and long-term dialysis as compared to patients without CKD or AKI. Thus, in a large cohort of postoperative patients who developed AKI, those with existing CKD were at higher risk for long-term mortality and dialysis after hospital discharge than those without. These outcomes were significantly worse in those with unresolved AKI at discharge. ? 2011 International Society of Nephrology.[SDGs]SDG3creatinine; acute kidney failure; adult; aged; article; chronic kidney failure; cohort analysis; controlled study; creatinine blood level; dialysis; disease association; disease course; female; follow up; glomerulus filtration rate; hazard ratio; high risk patient; hospital discharge; human; incidence; kidney surgery; long term care; major clinical study; male; mortality; multicenter study; outcome assessment; overall survival; priority journal; proportional hazards model; renal replacement therapy; risk assessmentjournal article10.1038/ki.2011.259218329832-s2.0-81155150125