1. ¹Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
2. ²Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
3. ³Department of Medicine, McMaster University, Hamilton, Ontario, Canada
4. ⁴Department of Medicine, Division of Nephrology, VA Medical Center San Francisco and University of California, San Francisco, California, USA
5. ⁵Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
6. ⁶Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada

Correspondence: AX Garg, London Kidney Clinical Research Unit, Room ELL-101, Westminster Tower, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada N6A 4G5. E-mail: amit.garg@lhsc.on.ca

Received 25 September 2007; Revised 2 December 2007; Accepted 12 December 2007; Published online 20 February 2008.

Abstract

Whether renal dysfunction is an important factor in postoperative risk assessment has been difficult to prove. In an attempt to provide more compelling evidence, we conducted a systematic review comparing the risk of death and cardiac events in patients with and without chronic kidney disease who underwent elective noncardiac surgery. From electronic databases, web search engines, and bibliographies, 31 cohort studies were selected, evaluating postoperative outcomes in patients with chronic kidney disease. These patients had higher risks of postoperative death and cardiovascular events compared to those with preserved renal function. The pooled incidence of postoperative death was significantly less in those with preserved renal function than in those patients with chronic kidney disease. Meta-regression showed a graded relationship between disease severity and postoperative death. In adjusted analysis, chronic kidney disease had a similar strength of association with postoperative death as diabetes, stroke, and coronary disease. Our review identifies chronic kidney disease as an independent risk factor for postoperative death and cardiovascular events after elective, noncardiac surgery.