Acute kidney injury after hepatectomy can be reasonably predicted after surgery

Abstract

Background Hepatectomy presents unique challenges potentially heightening acute kidney injury (AKI) risk, but the full spectrum of risk factors has not been identified.Methods Data for hepatectomy patients in the 2016 American College of Surgeons National Surgical Quality Improvement Program (n = 3,814) was randomly split into derivation (70%) and validation (30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5-fold above the preoperative value within 30 days of surgery. Multivariable logistic regression assessed preoperative and intraoperative risk factors for AKI. ResultsOf 2,692 patients (derivation cohort), 432 (16%) developed AKI. Risk factors were the following: age (years; adjusted odds ratio [aOR] 1.016 [95% confidence interval 1.006-1.026], female sex (aOR 0.65 [0.51-0.82]), body mass index (kg/m 2 ; aOR 1.043 [1.024-1.062]), diabetes (aOR 1.71 [1.31-2.24]), hypertension (aOR 1.66 [1.30-2.13]), hematocrit (%; aOR 0.944 [0.924-0.966]), operative time (min; aOR 1.004 [1.003-1.004]), planned open procedure (aOR 2.00 [1.47-2.73]), and Pringle maneuver (aOR 1.36 [1.07-1.72]). The areas under the curve of the receiver operating characteristic curves were 0.74 (95% CI 0.71-0.76) and 0.71 (95% CI 0.67-0.75) in the derivation and validation cohorts, respectively.Conclusions Postoperative AKI affects one in six hepatectomy patients; preoperative and intraoperative factors can predict the risk of postoperative AKI.

Acute kidney injury following hepatectomy and its impact on long-term survival for patients with hepatocellular carcinoma

“…According to this study, AKI occurred in almost one in ten patients who underwent hepatectomy. The incidence was similar that in other studies 4 , 5 , 11 using KDIGO criteria for AKI, reported as 15–16 per cent, and up to 21.6 per cent after major hepatectomy. Although nearly 70 per cent of patients with AKI eventually had complete recovery of renal function, having AKI was associated with increased hospital stay, morbidity and mortality.…”

“…Patients with DM were susceptible to renal hypoperfusion owing to associated nephropathy. Other studies 3 , 11 also showed that DM was a predictor of AKI. Mean BP was an important factor as the kidneys were most at risk from pressure drop.…”

“…Various predictors for AKI after hepatectomy were identified by previous studies 3–5 , 7 , 9 , 11 . Preoperative factors included age, sex, BMI, diabetes mellitus (DM), hypertension, cardiovascular disease, underlying chronic kidney injury (CKI), haematocrit, biliary obstruction, raised alanine aminotransferase level, and Model for End-Stage Liver Disease (MELD) score 12 .…”

Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

“…[38][39][40] Postoperative renal insufficiency is common following hepatectomy, with an incidence as high as 15%. 41,42 This increased incidence may allow for the identification of this statistically significant association between postoperative renal insufficiency and VTE, which has not previously been identified. Additionally, no prior study to our knowledge has identified an association between post-hepatectomy liver failure and VTE.…”

Association of intraoperative hypotension with acute kidney injury after liver resection surgery: an observational cohort study

“…Characteristics of liver resection including clamping of portal vein, massive bleeding and low central venous pressure (CVP) technique induce low MAP during surgery [ 10 – 12 ]. Several studies have identified risk factors for postoperative AKI [ 3 , 13 ]. However, the association between IOH and postoperative AKI in liver resection surgery was unknown.…”