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

Abstract

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.

Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial

“…However, removal of renal parenchyma [2,3], suture damage and ischemia-reperfusion injury [4] during partial nephrectomy all compromise renal function. The reported incidence of acute kidney injury (AKI) after partial nephrectomy ranged from 16.5-42%, and even up to 54% in solitary kidney patients [5][6][7]. In the study of Rajan et al [8], 39% of patients developed AKI after partial nephrectomy; speci cally, 33% had stage 1, 4% had stage 2, and 2% had stage 3 AKI after surgery.…”

“…In the study of Rajan et al [8], 39% of patients developed AKI after partial nephrectomy; speci cally, 33% had stage 1, 4% had stage 2, and 2% had stage 3 AKI after surgery. The occurrence of postoperative AKI is signi cantly associated with increased risks of renal function decline and chronic kidney diseases [6,9], as well as adverse cardiovascular events and even mortality [10].…”

Evaluation of Renal Function after Partial Nephrectomy and Detection of Clinically Significant Acute Kidney Injury

“…In most cases of the use of conventional diagnostic criteria of AKI, the incidence of AKI after partial nephrectomy was reported to be 20–54% [ 26 , 27 ]. These findings are in line with our results; 42% of patients after 48 h had postoperative AKI, but only 23% had clinically significant postoperative AKI.…”

Predicting the risk of postoperative acute kidney injury: development and assessment of a novel predictive nomogram

“…Many studies have been conducted to investigate which factors can accurately predict postoperative AKI, but the results are not consistent. 20 , 21 In this study, we established a prognostic model that included comprehensive preoperative predictors to determine the risk of AKI after nephrectomy to help urologists make timely clinical interventions before surgery. The incidence of postoperative AKI in this study was 33.27%, which is relatively high compared with other studies.…”