Risk factors of postoperative acute kidney injury in patients undergoing esophageal cancer surgery.

The purpose of this study was to identify perioperative risk factors for postoperative acute kidney injury (AKI) in patients undergoing esophageal cancer surgery. A retrospective analysis of the prospectively collected medical data. A tertiary care university hospital. All consecutive adult patients (n=595) who underwent elective esophageal surgery for cancer between January 2005 and April 2012. None. AKI was defined by the AKI Network criteria based on serum creatinine changes within the first 48 hours after esophageal cancer surgery. The relationship between perioperative variables and AKI was evaluated using multivariate logistic regression. Postoperative AKI developed in 210 (35.3%) patients. Risk factors for AKI were body mass index (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.14), preoperative serum albumin level (OR 0.52; 95% CI 0.33-0.84), use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (OR 1.35; 95% CI 1.05-1.75), colloid infusion during surgery (OR 1.11; 95% CI 1.06-1.18), and postoperative 2-day C-reactive protein (OR 1.05; 95% CI 1.01-1.09). Postoperative AKI was associated with prolonged length of hospital stay. Postoperative AKI is common in patients undergoing esophageal surgery for cancer. Closer evaluation and monitoring in patients with risk factors for AKI may be warranted.

Lee EH ，Kim HR ，Baek SH ，Kim KM ，Chin JH ，Choi DK ，Kim WJ ，Choi IC ... -  《-》

Acute kidney injury after lung resection surgery: incidence and perioperative risk factors.

Ishikawa S ，Griesdale DE ，Lohser J 《-》

Risk factors for acute kidney injury after radical nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma.

The objectives of the present study are to estimate the incidence of postoperative acute kidney injury (AKI) after radical nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) based on the Acute Kidney Injury Network (AKIN) criteria, to investigate the risk factors for postoperative AKI, and to define the association between postoperative AKI and clinical outcome in patients undergoing such a surgery. We retrospectively analyzed 76 patients (22 women; mean age, 56.9 years; range, 29-83 years) with RCC and IVC thrombus who underwent radical nephrectomy and IVC thrombectomy at our institute between January 2003 and December 2011. Postoperative AKI was diagnosed after surgery based on the AKIN criteria. Logistic regression was used to model the association between preoperative factors and the risk of AKI after surgery. The relationship between postoperative AKI and clinical outcomes, including chronic kidney disease (CKD), mortality, and days in hospital, was investigated. Postoperative AKI was diagnosed in 41 patients (53.9%) based on the AKIN criteria (stage 1, n = 34; stage 2, n = 2; and stage 3, n = 5). Multivariate analysis demonstrated an independent association between postoperative AKI and male gender (odds ratio 4.79, 95% confidence interval: 1.13-20.39; P = .034), and IVC clamping time lasting more than 20 minutes (odds ratio 6.60, 95% confidence interval: 1.48-29.42; P = .013). Development of AKI was associated with an increased rate of postoperative CKD (43.9% vs 20.0%; P = .031) and prolonged hospitalization (17.7 vs 12.2 days; P = .047). Only one patient who had postoperative AKI required renal replacement therapy. There was no 30-day mortality during the study period and no difference in mortality between AKI and non-AKI patients (4.9% vs 5.7%; P = .859). The incidence of postoperative AKI in patients with RCC and IVC thrombus was considerable. Intraoperative management seems to influence the risk of AKI after surgery; particularly, the longer the IVC clamping time, the higher the risk of postoperative AKI. Postoperative AKI was associated with postoperative CKD (P = .031), prolonged hospitalization (P = .047), and increased long-term mortality (1 year after surgery).

Shin S ，Han Y ，Park H ，Chung YS ，Ahn H ，Kim CS ，Cho YP ，Kwon TW ... -  《-》

Incidence and risk factors of acute kidney injury after esophageal cancer surgery: A nested case-control study.

Acute kidney injury (AKI) has been increasingly recognized as a common and serious postoperative complication. Although many studies have been conducted to investigate postoperative AKI after thoracic surgery, little is known about AKI after esophageal surgery. Thus, we conducted this study to determine the incidence and identify risk factors of postoperative AKI after esophageal cancer surgery. A retrospective nested case-control study of patients undergoing elective esophageal cancer surgery between July 2013 and July 2016 in a single tertiary specialized cancer hospital was performed. The primary outcome was development of AKI. Conditional logistic regression analysis was performed to identify independent risk factors for AKI. Of 2094 patients, 51 (2.4%) developed postoperative AKI after esophageal cancer surgery. In multivariate conditional logistic regression analysis, four risk factors for AKI after esophageal surgery for cancer were identified: preoperative serum creatinine level (OR 1.040; 95% CI 1.012-1.069), duration of surgery (OR 1.009; 95% CI 1.005-1.014), smoking history (OR 3.029; 95% CI 1.092-8.399) and hypertension (OR 6.422; 95% CI 2.736-15.070). Postoperative AKI occurred in 2.4% of patients after esophageal surgery for cancer. Preoperative serum creatinine level, duration of surgery, smoking history and hypertension were independent risk factors for postoperative AKI.

Wang W ，Wang T ，Feng X ，Sun L ... -  《-》

Acute kidney injury within 72 hours after lung transplantation: incidence and perioperative risk factors.

To define the incidence and perioperative risk factors of acute kidney injury (AKI) within 72 hours after lung transplantation and clarify the relationship between postoperative AKI and outcome in patients undergoing lung transplantation. A retrospective observational study. A tertiary care academic center. Fifty-four patients who underwent lung transplantation between January 2006 and March 2010. None. After excluding 4 patients who died or required additional surgery during the first 72 hours after transplantation, 50 patients were included in the final analysis. Data were extracted from medical charts and electronic health record information system. Risk, injury, failure, loss, endstage (RIFLE) renal disease creatinine criteria were used for the diagnosis of AKI. AKI developed in 27 patients (54%) within 72 hours after transplantation. The incidence of AKI after double-lung transplantation was 87% compared to 40% following single-lung transplantation. The percentage of patients with intraoperative hypoxemia (SpO2<90%) was significantly different between the groups (AKI, 59%; Non-AKI, 22%). Volume of hydroxyethyl starch was significantly higher in AKI patients (912±507 mL) than non-AKI patients (535±338 mL). Baseline estimated glomerular filtration rate (eGFR) was significantly higher in AKI patients (99±27 mL/min/1.73 m2) than non-AKI patients (77±20 mL/min/1.73 m2). AKI based on the RIFLE criteria following lung transplantation is common. Patients who developed AKI were more likely to have an episode of intraoperative hypoxemia and undergo a double-lung transplantation. Contrary to other published studies, patients with a higher preoperative eGFR were more likely to develop AKI in the authors' cohort.

Ishikawa S ，Griesdale DE ，Lohser J 《-》