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. 2021 May 11;17(9):605–618. doi: 10.1038/s41581-021-00418-2

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Postoperative acute kidney injury (PO-AKI) occurs when the Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI are met within 7 days of an operative intervention. Postoperative acute kidney disease (PO-AKD) occurs when patients with PO-AKI continue to meet KDIGO AKI criteria ≥7 days after surgery or when patients whose serum creatinine levels began to rise following surgery meet KDIGO AKI criteria ≥7 days after surgery. A number of potential trajectories of serum creatinine are depicted with suggested application of the proposed nomenclature. PO-AKI might commence and resolve before postoperative day 7 or persist after postoperative day 7 and therefore be classed as PO-AKD. If PO-AKD continues after postoperative day 90 it will be classed as chronic kidney disease (CKD) (trajectory 1). PO-AKD also occurs when evidence of new kidney injury was present before postoperative day 7 but did not meet the criteria for PO-AKI until after postoperative day 7. This form of PO-AKD might also either recover before postoperative day 90 or continue after postoperative day 90 and be classed as CKD (trajectory 2). Stand-alone AKI or AKD (that is, AKI or AKD that is seemingly not related to the operative intervention) can also occur during the perioperative period. As these new events occur distant to the surgical insult they should not be referred to as PO-AKI or PO-AKD and should be considered in the context of their direct precipitants (trajectory 3). Subclinical kidney injury can occur before or after postoperative day 7 (trajectory 4). This subclinical injury does not meet current criteria for AKI or AKD, but may be identified by risk-based serial kidney health assessments (KHAs). Source: Adapted from Acute Disease Quality Initiative 24, www.ADQI.org, CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/).