Glomerular hyperfiltration is an independent predictor of postoperative outcomes: A NSQIP multi-specialty surgical cohort analysis

Carlos Riveros, Sanjana Ranganathan, Emily Huang, Adriana Ordonez, Jiaqiong Xu, Michael Geng, Brian J. Miles, Nestor Esnaola, Zachary Klaassen, Angela Jerath, S. Joseph Kim, Christopher J.D. Wallis, Raj Satkunasivam

Research output: Contribution to journalArticlepeer-review


Aim: While high estimated glomerular filtration rate (eGFR) has been associated with increased overall mortality, its effect on postoperative outcomes is relatively understudied. We sought to investigate the association between high eGFR and 30-day postoperative outcomes using a multi-specialty surgical cohort. Methods: Using the National Surgical Quality Improvement Program database, we selected adult for whom eGFR could be calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration equation. Based on sex-specific distributions of eGFR stratified by age quintiles, we classified patients into low (<5th percentile), normal (5–95th percentile) and high eGFR (>95th percentile). The primary outcome was a composite of any 30-day major adverse outcomes, including: death, reoperation, cardiac arrest, myocardial infarction and stroke. Secondary outcomes included 30-day infectious complications, venous thromboembolism (VTE), bleeding requiring transfusion, prolonged length of stay and unplanned readmission. After matching for demographic differences, comorbidity burden and operative characteristics, logistic regression models were used to evaluate the association between extremes of eGFR and the outcomes of interest. Results: Of 1 668 447 patients, 84 115 (5.07%) had a high eGFR. High eGFR was not associated with major adverse outcomes (odds ratio [OR] 1.00 [95% confidence interval (CI): 0.97, 1.03]); however, it was associated with reoperation (OR 1.04 [95% CI: 1.00,1.08]), infectious complications (OR 1.14 [95% CI: 1.11, 1.16]), VTE (OR 1.15 [95% CI: 1.09, 1.22]) and prolonged length of stay (OR 1.19 [95% CI: 1.16, 1.21]). Conclusion: Our findings support an association between high eGFR and adverse 30-day postoperative outcomes.

Original languageEnglish (US)
Pages (from-to)548-556
Number of pages9
Issue number10
Early online dateJul 19 2023
StateE-pub ahead of print - Jul 19 2023


  • chronic kidney disease
  • glomerular filtration rate
  • outcome assessment
  • postoperative complication
  • preoperative care

ASJC Scopus subject areas

  • Nephrology


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