Incidence, Predictive Factors, and Clinical Outcomes of Acute Kidney Injury after Gastric Surgery for Gastric Cancer

Abstract

BackgroundPostoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes.MethodsWe conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline.ResultsOf the 4718 patients, 679 (14.4%) developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2%) were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl); use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments.ConclusionsAKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.

Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome

“…25 Another study examining AKI after gastric surgery among cancer patients, using the KDIGO criteria, observed a rate of 14.4%. 2 In the present study, the rate of AKI after hepatic and other biliary surgery (excluding cholecystectomy) was 8.3%, a rate similar to the 7.6% observed by Cho et al 26 after hepatobiliary surgery, using the AKIN criteria. However, direct comparison is difficult as the study by Cho et al included both cholecystectomy, which is classified as high-volume and low-risk procedure and liver transplantation that is associated with a very high rate of postoperative AKI, or in the 63% to 95% range.…”

“…1 Acute kidney injury (AKI) is a serious perioperative complication and is associated with increased costs, prolonged hospital stay, and both short-and long-term mortality. [2][3][4] Surgery is considered the leading cause of approximately one-third of in-hospital AKI. 5 However, studies on postoperative AKI have been hampered by the lack of uniform definitions and different diagnostic criteria.…”

The Use of Intraoperative Dexmedetomidine Is Not Associated With a Reduction in Acute Kidney Injury After Lung Cancer Surgery

“…All of those are risk factors for postoperative AKI after major noncardiac surgery. 3,23 Obesity was also an independent predictor of AKI. Although 2 recent studies also have shown this association, the exact mechanisms that link obesity and AKI remain unknown.…”

“…This was in line with previously published findings in the context of major oncologic surgery. 23 An ASA 3-4 physical status showed a 10-fold increase in AKI incidence. It could be speculated that patients with a greater number of poorly controlled comorbidities have a higher risk of developing AKI because they might present with subclinical renal damage secondary to systemic disease such as arterial hypertension (a known risk factor for renal insufficiency).…”

Long-term Mortality Outcomes of Hyperkalemic Patients in the Emergency Department Setting: A Case Control Study

“…Shiyovich et al showed that potassium >4.5 mEq/L is significantly associated with increased post-discharge long-term mortality in acute MI over median follow up of 8.1 years [26]. A similar study Choi et al showed mortality risk was greater for serum potassium >4.5 mEq/L (HR1.71, 95% [CI] 1.04 to 2.81 4.5 to <5.0 mEq/L and HR 4.78, 95% CI 2.14 to 10.69 for >5.0 when compared to patients with potassium levels of 3.5 to <4.0 mEq/L over mean of 3.58 year follow-up [27].…”