Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

Kim, Na Young; Hong, Jung Hwa; Koh, Dong Hoon; Lee, Jongsoo; Nam, Hoon Jae

doi:10.3390/jcm8040468

Cited by 21 publications

(24 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After approval from the IRB, we reviewed the electronic medical records of 1087 adult patients underwent radical or partial nephrectomy due to a renal mass at our hospital between 2010 and 2014. Demographic or perioperative variables known to be associated with AKI or CKD after nephrectomy were collected (Table 1) [9,10,12]. The cohort was divided into three groups according to the anesthetic agents commonly used for maintenance of general anesthesia; propofol, sevoflurane, and desflurane.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

General Anesthetic Agents and Renal Function after Nephrectomy

Lee

Bae

Kwon

et al. 2019

JCM

View full text Add to dashboard Cite

The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) and CKD upstaging were compared between general anesthetic agent groups (propofol, sevoflurane, and desflurane). Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs. sevoflurane; propofol vs. desflurane; sevoflurane vs. desflurane; propofol vs. volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of new-onset CKD between groups up to 36 months after nephrectomy. Propofol was associated with a lower incidence of AKI (propofol 23.2% vs. sevoflurane 39.5%, p = 0.004; vs. propofol 21.0% vs. desflurane 34.3%, p = 0.031), a lower incidence of CKD upstaging (propofol 27.2% vs. sevoflurane 58.4%, p < 0.001; propofol 32.4% vs. desflurane 48.6%, p = 0.017) and better three-year renal survival after nephrectomy compared to sevoflurane or desflurane group (Log-rank test propofol vs. sevoflurane p < 0.001; vs. desflurane p = 0.015) after matching. Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (p < 0.001). There were no significant differences between sevoflurane and desflurane. However, subgroup analysis of partial nephrectomy showed a significant difference only in CKD upstaging. In conclusion, propofol, compared to volatile agents, could be a better general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. However, limitations of the retrospective study design and inconsistent results of the subgroup analysis preclude firm conclusions.

show abstract

Section: Methodsmentioning

confidence: 99%

“…Previous studies investigated perioperative predictors for AKI and CKD after nephrectomy [9,10,11,12]. However, to our knowledge, previously reported risk factors were generally not modifiable except ischemic time during renal arterial clamping, cold ischemia during partial nephrectomy, and intraoperative hypotension [9,13,14,15].…”

Section: Introductionmentioning

confidence: 94%

General Anesthetic Agents and Renal Function after Nephrectomy

Lee

Bae

Kwon

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…Although we cannot reduce the loss of nephrons in patients for whom nephron-sparing surgery is not feasible, injury of the contralateral kidney could be prevented by hemodynamic optimization during the perioperative period [43]. Previously reported risk factors of male sex, old age, high body-mass index, hypertension, diabetes mellitus, preoperative proteinuria, high preoperative eGFR are not modifiable [1,2,21,[44][45][46]. Comorbidities such as hypertension or diabetes could contribute to the underlying medical renal disease and long-term renal functional deterioration [47].…”

Section: Discussionmentioning

confidence: 99%

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Shin

Jang

et al. 2020

JCM

View full text Add to dashboard Cite

The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

show abstract

“…Demographic, baseline characteristics and surgery-related parameters that were known to be associated with renal function after nephrectomy were extracted from our electronic medical records (Table 1) [1,2,6,11,12,13]. Serum creatinine values measured 3 to 60 months after surgery were collected.…”

Section: Methodsmentioning

confidence: 99%

Acute Kidney Injury Adjusted for Parenchymal Mass Reduction and Long-Term Renal Function after Partial Nephrectomy

Yoon

Lee

Yoo

et al. 2019

JCM

View full text Add to dashboard Cite

We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3–12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3–12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (β = −0.129 ± 0.026, p < 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (β = −0.243 ± 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.

show abstract

Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

Cited by 21 publications

References 32 publications

General Anesthetic Agents and Renal Function after Nephrectomy

General Anesthetic Agents and Renal Function after Nephrectomy

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Acute Kidney Injury Adjusted for Parenchymal Mass Reduction and Long-Term Renal Function after Partial Nephrectomy

Contact Info

Product

Resources

About