Acute Kidney Injury After Esophageal Cancer Surgery

Abstract

Objective: To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer Summary of Background Data: Esophageal cancer surgery is an exemplar of major operative trauma, with well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI. Methods: consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 mmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI. Results: A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m À2 , and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age [P ¼ 0.027, odds ratio (OR) 1.02 (1.00-1.04)], male sex [P ¼ 0.015, OR 1.77 (1.10-2.81)], BMI at diagnosis [P < 0.001, OR 1.10 (1.07-1.14)], and dyslipidemia [P ¼ 0.002,]. Postoperatively, AKI was associated with atrial fibrillation (P ¼ 0.013) and pneumonia (P ¼ 0.005). Postoperative AKI did not impact survival outcomes. Conclusion:AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.

Clinical Characteristics and Risk Factors Associated With Acute Kidney Injury Inpatient With Exertional Heatstroke: An Over 10-Year Intensive Care Survey

“…The underlying mechanism may be that EHS leads to severe injury in other organs, such as the brain, or DIC, which has a greater impact on 90-day mortality than AKI. These results are different from those associated with sepsis or surgery (29)(30)(31). But this result still needs a large sample study to be confirmed in the future.…”

Incidence and Associations of Acute Kidney Injury after General Thoracic Surgery: A System Review and Meta-Analysis

“…In total, our search identified 1260 records of which 113 records were removed as duplicates and a further 1091 records were excluded for not meeting our eligibility criteria upon the screening of the title and abstract. After a full-text examination, 18 studies met our selection criteria [5][6][7][8][9][10][11][12][27][28][29][30][31][32][33][34][35][36]. The reference lists for the bibliographies of the text articles were screened, which revealed two reports that met our inclusion criteria [19,37].…”

“…Table 1 presents the clinical characteristics of all the included studies. Of the 20 studies analyzed, 15 were retrospective observational studies [5-7,9,19,27-31,33-37], 4 were prospective observational studies [8,11,12,32], and 1 was a retrospective nested casecontrol study [10]. Two studies documented mixed thoracic surgical populations [19,29], thirteen documented lung surgical populations [5,7,9,11,12,27,30,[32][33][34][35][36][37], and five were of esophageal surgical populations [6,8,10,28,31].…”

“…Any disagreement between the review authors was resolved through consensus, or where necessary, by a third party (X.T.). Studies were allocated a maximum of 9 points in value and defined as good (7)(8)(9), fair (4)(5)(6), or poor (0-3).…”

“…Acute kidney injury (AKI) is increasingly recognized as a common and serious complication after thoracic surgery, with incidence levels ranging from 2.2% to 35.3% [6][7][8], and it is related to long-term adverse consequences, including the progression to chronic kidney disease (CKD), as well as higher rates of cardiovascular disease and mortality [9][10][11][12]-even if renal function is clearly recovered at the time of discharge [5,8,12]. Hence, this might be significative of how, as a measurable signal of a prognostic indicator, postoperative AKI can be targeted for treatment.…”