Perioperative factors associated with acute kidney injury after partial nephrectomy

Rajan, Shobana; Babazade, Rovnat; Govindarajan, Srinivasa; Pal, Rajib; You, Jing; Mascha, Edward J.; Khanna, Abhinav; Yang, Mikyung; Marcano, F.D.; Singh, A. K.; Kaouk, Jihad; Turan, Alparslan

doi:10.1093/bja/aev416

Cited by 47 publications

(66 citation statements)

References 19 publications

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“…We also found that, in the short term, further significant factors influencing the postoperative evolution of renal function were male sex (HR, 31.401), albumin levels (HR, 0.010), and ECOG score (0 and 1, HR < 1.0), which were previously reported as factors affecting renal function [16–18]. Patients with good nutritional status and general performance in the preoperative stage are expected to have good baseline renal function and postoperative recovery after PN [16].…”

Section: Discussionsupporting

confidence: 71%

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

Kim

Joung

Seo

et al. 2016

BioMed Research International

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The renal functions of 215 patients (24 with benign renal mass, the rest with RCC staged T1-T2) who underwent partial nephrectomy (PN) between 2003 and 2014 were evaluated to identify predictors of short- and long-term deterioration in renal function after PN among renal cell carcinoma (RCC) patients with or without preoperative predisposition to chronic kidney disease (CKD) and among patients with benign renal mass. The 1- and 5-year predictive factors for de novo CKD were statistically analyzed. The incidence of de novo CKD differed significantly (p < 0.001) among patients with benign renal mass, those with RCC but no preoperative CKD predisposition, and those with RCC combined with preoperative CKD predisposition. Independent predictors for de novo CKD at 1 year postoperatively included intraoperative ischemic method, ECOG score, elevated albumin levels, male sex, and smoking exposure (in pack-years). Predictors for de novo CKD at 5 years postoperatively included hypertension, high preoperative albumin levels, De Ritis ratio (aspartate aminotransferase/alanine aminotransferase ratio), smoking exposure, and preoperative predisposition to CKD. Preoperative predisposition to CKD and ischemic method applied during PN, along with other preoperative parameters, were important factors affecting postoperative renal function deterioration in patients with T1-T2 RCC.

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Section: Discussionsupporting

confidence: 71%

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

Kim

Joung

Seo

et al. 2016

BioMed Research International

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“…Patients undergoing surgery for a renal tumor are at high risk for AKI because of the nephron loss involved in the surgical procedures for renal tumors. Some studies have shown several factors associated with AKI after PN . Among them, renal ischemia is one of the most important.…”

Section: Discussionmentioning

confidence: 94%

Acute kidney injury and intermediate‐term renal function after clampless partial nephrectomy

et al. 2018

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Objectives To evaluate the incidence and predictors of acute kidney injury after clampless partial nephrectomy, and its impact on intermediate‐term renal function. Methods The incidence and severity of acute kidney injury were assessed for 262 patients undergoing clampless partial nephrectomy between 2010 and 2015. The association between perioperative covariates and acute kidney injury was evaluated using multivariate logistic regression analysis. An annual change in estimated glomerular filtration rate from 1 year after surgery was calculated according to the presence or absence of acute kidney injury. An impact of acute kidney injury on postoperative renal impairment, defined as a ≥25% estimated glomerular filtration rate decrease, was evaluated. Results Overall, 21 (8.0%) patients experienced grade 1 acute kidney injury after clampless partial nephrectomy, and grade ≥2 acute kidney injury was not observed. High tumor complexity was the only independent predictor of acute kidney injury. Estimated glomerular filtration rate in patients with acute kidney injury improved within 1 year, and annual estimated glomerular filtration rate changes were similar among patients with or without acute kidney injury. Ultimately, 13 (5.0%) patients showed postoperative renal impairment during the median follow‐up period of 37 months. Advanced age and diabetes mellitus were independent risk factors for renal impairment, but acute kidney injury was not. Conclusions The incidence and severity of acute kidney injury after clampless partial nephrectomy are low. Low‐grade acute kidney injury after clampless partial nephrectomy does not seem to affect intermediate‐term renal function.

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“…Rajan et al (13) found that 39% of his patients had ARF after partial nephrectomy. However, Thompson et al (5) and Weight et al (6) reported that 60% of patients had some type of kidney dysfunction after surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute renal failure in nephrectomized patients treated in a university hospital

Fantin

Neiva

Gatti

et al. 2017

Transl. Androl. Urol.

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BackgroundNew surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital.MethodsSeventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed.ResultsOf the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001).ConclusionsAn altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.

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Perioperative factors associated with acute kidney injury after partial nephrectomy

Abstract: Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.

Cited by 47 publications

References 19 publications

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

Baseline Chronic Kidney Disease and Ischemic Method of Partial Nephrectomy Are Important Factors for the Short- and Long-Term Deterioration in Renal Function for Renal Cell Carcinoma Staged T1-T2: A Retrospective Single Center Study

Acute kidney injury and intermediate‐term renal function after clampless partial nephrectomy

Risk factors for acute renal failure in nephrectomized patients treated in a university hospital

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