Kidney Failure and Dialysis After Surgery

Risk factors, diagnosis and treatments for kidney failure after surgery

Normal Kidney Anatomy Image
Normal Kidney Anatomy. Image: National Institute of Health

When planning to have surgery, most people do not consider the possibility that they will have a serious or life-threatening complication.  Unfortunately, some people do have significant complications during their recovery, and one of those is renal failure.  The risks of surgery vary from patient to patient, based on their age, health and the nature of their illness. 

Renal failure is the medical term for kidney failure, and it means that the kidneys are unable to work well enough to filter the blood effectively.

  The term renal failure is the most commonly used term at this time, but you may hear the diagnosis of acute kidney injury (AKI) which typically indicates a mild level of kidney failure.

Kidney Failure After Surgery

The kidneys work to remove waste material from the blood.  They filter the blood in the human body hundreds of times per day, removing excess water and waste from the blood and turning it into the urine.  

When an individual experiences kidney failure for the first time, they have acute kidney failure, meaning that it is a sudden problem and may be able to be fixed.  Chronic renal failure is the term for kidneys that are permanently damaged.

The severity of kidney failure is measured primarily by laboratory results of a renal function panel that includes creatinine, as well as several other lab results including BUN, GFR, and creatinine clearance.  Kidney failure is diagnosed when the creatinine level is 1.5 times the patient’s initial creatinine level if the kidneys were functioning normally at the time of the test.


A creatinine level less than 1.2 milligrams per deciliter is desirable for men, and less than 1.1 is healthy for women.  

For example, a man who has a creatinine of .8 mg/dl before surgery is well within the normal range.  If he had a creatinine level of 1.6 after surgery the next day, he would be diagnosed with acute renal failure.

The diagnosis can also be made based on urine output.  Urine output of fewer than .5 milliliters of urine per kilogram of body weight per hour that lasts for six hours or more indicates a serious kidney injury.

Sometimes this problem is easily solved with increasing fluid intake, which typically increases urine output and allows the kidneys to work efficiently again.  For others, the kidneys have sustained damage and no longer work as efficiently as they did prior to surgery. Luckily for most individuals, damaged kidneys can often work well enough to keep the body healthy. 

In severe cases, the kidneys are unable to filter the blood at all, and cannot make urine.  The inability to make urine is a serious problem and medical attention should be sought immediately if it occurs while recovering at home. 

Common Kidney Problems After Surgery

Dialysis After Surgery

Dialysis is typically done when the kidneys cannot function well enough to keep the body healthy.  There is no single creatinine level that indicates dialysis should be done, some sources say a creatinine of 8 should lead to dialysis, others say 10.  Still, others say that the creatinine level is just one part of the puzzle, and the symptoms the patient is experiencing should guide treatment more than laboratory results.

What Is Dialysis?

Dialysis is a treatment that performs the work that the kidneys are no longer able to do: the filtration of the blood to remove toxins, electrolytes, and excess water.  During dialysis, a large IV type line is placed in a blood vessel. Blood travels out of the body from that IV site via a tube, and the dialysis machine filters the blood and then returns it to the body.  This process typically takes four to six hours and is done three times a week or more, depending on the needs of the individual. 

A physician specializing in the treatment of kidneys, called a nephrologist, determines the settings for the dialysis machine including how much excess fluid should be removed from the body.

Risk Factors for Kidney Failure After Surgery

One known risk factor for kidney failure after dialysis is having open heart surgery or vascular surgery (a procedure performed on the blood vessels).  These types of the procedure can dramatically increase the risk of having kidney damage that is severe enough to require dialysis treatments, either for the short term or the long term.

Having reduced kidney function prior to surgery is also a significant risk factor.  Those who have already sustained kidney damage are more likely to have increased damage after surgery.

Older patients are more likely to sustain a kidney injury than a younger patient, as younger patients tend to be healthier prior to the procedure.  Patients with high blood pressure, heart disease and diabetes are at higher risk.

Decreased levels of oxygen in the blood for an extended period of time can damage the kidneys.  Traumatic injuries, significant blood loss, low blood pressure for extended periods of time, and developing a severe infection called septic shock before, during or after surgery can also increase the chances of dialysis after surgery.  

Developing a severe urinary tract infection after surgery, if untreated or the infection does not respond to treatment, can result in kidney damage. 

In general, the sicker/more injured the patient is immediately before surgery and in the days following the procedure, the higher the likelihood of kidney damage being diagnosed.

Long-Term Versus Short-Term Dialysis

For most surgery patients who experience kidney failure, dialysis is not necessary, and the problem either resolves or improves enough to sustain good health.  

For individuals who experience kidney failure after surgery and require dialysis,  the problem is an acute one, and the kidney function improves enough that dialysis is not necessarily long term.  This type of illness is called Acute Renal Failure, or ARF. 

For others, the kidney damage is permanent and is severe enough that dialysis is necessary.  For those individuals, the problem is a chronic one and will require dialysis unless they obtain a kidney transplant.  This type of issue is referred to as End Stage Renal Disease (ESRD) or chronic renal failure. 


Acute Kidney Injury after Major Abdominal Surgery: A Retrospective Cohort Analysis.  Critical Care Research and Practice.