Preexisting CKD Elevates Risk of Renal Deterioration following Abdominal Wall Reconstruction

Messer N; Miller BT, Beffa LRA, et al. Impact of Large Ventral Hernia Repair on Postoperative Renal Function. J Am Coll Surg. 2025; in press. 

Large hernia repairs, particularly those involving abdominal wall reconstruction (AWR), can elevate intra-abdominal pressure (IAP) due to the reintegration of herniated contents into the abdominal cavity, potentially contributing to renal injury. Despite this theoretical risk, the long-term impact of AWR-induced IAP elevation on renal function has been insufficiently studied. 

Researchers from Tel Aviv, Israel, Cleveland, Ohio, and Nashville, Tennessee, collected data on 1,164 patients who underwent elective open ventral hernia repair with transversus abdominis release and permanent synthetic mesh between 2014 and 2022, as well as had complete serum creatinine data and 1-year postoperative follow-up. 

They found that among patients with normal baseline renal function, 11.8% developed postoperative acute kidney injury (AKI) and 6.9% progressed to new-onset CKD at 1 year. None of these patients required permanent dialysis. Among patients with preexisting CKD, 26.6% experienced postoperative AKI and 19.6% demonstrated CKD progression at 1 year. Notably, 5.4% of patients in this cohort required long-term dialysis.

The authors wrote: “Given these findings, perioperative risk stratification and vigilant postoperative renal monitoring are essential. Prevention and early management of AKI should be prioritized to mitigate long-term renal complications in this high-risk population.”