Chronic Kidney Disease (CKD) Predicts Acute Kidney Injury (AKI) After Renal Cell Carcinoma Surgery
Other predictors include neurovascular disease, obesity, and surgical approach.
Preoperative chronic kidney disease (CKD) stage 2 and 3, a history of neurovascular disease, and obesity are among the factors that independently predict development of acute kidney injury (AKI) within 30 days of undergoing radical (RN) or partial (PN) nephrectomy, according to researchers.
Marianne Schmid, MD, of Brigham and Women's Hospital, Harvard Medical School in Boston, and University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and colleagues studied 3,320 patients who underwent surgery for renal cell carcinoma (RCC), including 1,944 patients (58.6%) and 1,376 (41.4%) patients who underwent RN or PN, respectively.
Patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 were excluded from the analyses.
AKI—defined as a greater than 2 mg/dL rise in serum creatinine above baseline or the need for dialysis within 30 days of surgery—developed in 60 patients (1.8%) within an average of 5.4 days after RN or PN. Preoperative stage 2 and 3 CKD was associated with 10- and 26-fold higher odds of 30-day AKI, respectively. A history of neurovascular disease and obesity were associated with 5- and 2-fold higher odds of 30-day AKI, respectively, according to findings published online ahead of print in Urologic Oncology.
In addition, compared with PN, RN was associated with nearly 3-fold higher odds of 30-day AKI. An open surgical approach was associated with 2-fold higher odds compared with a minimally invasive approach. Importantly, AKI was associated with adverse postoperative outcomes such as prolonged length of hospital stay, postoperative complications and mortality.
“Preoperative evaluation of kidney function and identification of predictors for postoperative AKI are important components of preoperative individual risk assessment and counseling in RCC patients undergoing surgery,” the authors concluded.