NEPHROLOGY - ORIGINAL PAPER Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances Andreas Heller • Saskia E. Westphal • Peter Bartsch • Michael Haase • Peter R. Mertens Received: 20 March 2013 / Accepted: 7 September 2013 / Published online: 29 September 2013 Ó Springer Science+Business Media Dordrecht 2013 Abstract Background and objectives Incisional hernias are among the most frequent complications following abdominal sur- gery with impact on morbidity and mortality rates. Ele- vated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development. Here, we quantified the hazard ratio for incisional hernia prevalence in patients at risk undergoing abdominal reoperations with interrela- tionship to kidney function. In the same cohort, incidence rates for de novo wound healing disturbances within a 4-month follow-up period were determined. Design, setting, participants and measurements Upon hospitalization for elective abdominal surgery in a uni- versity hospital (tertiary medical center), past medical histories were recorded in 251 patients and incisional hernia prevalence rates were calculated. Known modifiers for hernia formation as well as laboratory values for esti- mated glomerular filtration rate (eGFR) were recorded. The status of wound healing was assessed by a blinded inves- tigator 4 months postoperatively. Chronic kidney disease (CKD) was defined as eGFR \ 60 ml/min/1.73 m 2 . To identify independent risk factors for incisional hernia or postoperative wound healing disorder, multivariate regression analyses were performed. Results The incisional hernia prevalence was 24.3 % in the overall cohort. Patients with CKD (32/251; 12.8 %) were more likely to suffer from incisional hernias with an odds ratio (OR) of 2.8 ([95 % CI 1.2–6.1]; p = 0.014) than patients with eGFR [ 60 ml/min (219/251; 88.2 %). In multivariate analyses, CKD proved to be an independent risk factor for incisional hernia development with an OR similar to obesity (BMI [ 25; OR 2.6 [95 % CI 1.3–5.1]; p = 0.007). In the prospective analysis, disturbed wound healing occurred in 32 of 251 (12.8 %) patients undergoing abdominal operations. Frequency of wound healing was increased when CKD was present (8/32; 25 %; OR 2.3 [95 % CI 1.1–6.7]; p = 0.026) compared to patients with eGFR [ 60 ml/min (24/219; 11 %). Conclusions Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development. Keywords Chronic kidney disease Á Incisional hernia Á Wound healing complication Á Obesity Á Risk factor Introduction Incisional hernias are frequent following abdominal opera- tions, with higher morbidity and mortality rates as well as prolonged hospitalization periods [7, 8, 27]. Reoperations may be required when intestinal motility disorders ensue, e.g., with potentially life-threatening bowel incarceration; on the other hand, cosmetical aspects are of serious concern. Long- term follow-up after abdominal surgery reveals an incidence rate of 5–25 % for incisional hernias [11, 21, 22, 25, 29]. Patients’ intrinsic (age, gender, obesity, anemia, diabe- tes mellitus, collagen synthesis disorders) and extrinsic A. Heller (&) Á P. Bartsch Á M. Haase Á P. R. Mertens Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany e-mail: andreas.heller@med.ovgu.de S. E. Westphal Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany 123 Int Urol Nephrol (2014) 46:1175–1181 DOI 10.1007/s11255-013-0565-1