Identification of Risk Factors Associated With Postoperative Acute Kidney Injury After Esophagectomy for Esophageal Cancer

Prameela Konda, Di Ai, Carlos E. Guerra, Andrea Rodriguez-Restrepo, Reza J. Mehran, David Rice, Wayne Hofstetter, Jagtar Heir, Peter Kwater, Vijaya Gottumukkala, Mike Hernandez, Juan P. Cata

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To identify risks factors associated with acute kidney injury (AKI) after esophageal cancer surgery. Design: This was a retrospective study. Setting: Single academic center. Participants: Subjects with non-metastatic esophageal cancer. Patients were excluded if they were younger than 18 years and had missing data. Measurements and Main Results: Primary outcome of the study was AKI according to AKI Network criteria. Demographic and perioperative variables were compared in patients with and without AKI. A multivariate Cox proportional model was used to assess the association between perioperative variables and AKI; p<0.05 was considered statistically significant. AKI was found in 107 (11.9%) of the 898 patients included in the study. The multivariate analysis also showed that BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), number of comorbidities (OR 1.52, 95% CI 1.20-1.93, p = 0.001), and preoperative creatinine concentrations (OR 2.37, 95% CI 1.14-4.92, p = 0.02) were independent predictors for AKI. The use of dexamethasone was associated with a reduced risk for AKI. Conclusions: In support of previous reports in the literature, the authors found that AKI was not an uncommon complication after esophageal surgery. Obesity, cardiovascular comorbidities, and high preoperative concentrations were predictors of AKI. Dexamethasone administration during surgery appeared to have a protective effect. This finding opens an opportunity to further study in a randomized controlled trial the efficacy of dexamethasone in the prevention of AKI.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Esophagectomy
Esophageal Neoplasms
Acute Kidney Injury
Dexamethasone
Odds Ratio
Confidence Intervals
Comorbidity
Proportional Hazards Models
Creatinine
Multivariate Analysis
Randomized Controlled Trials
Retrospective Studies
Obesity
Demography
Outcome Assessment (Health Care)

Keywords

  • Acute kidney injury
  • Esophageal neoplasms
  • Esophagectomy
  • Outcomes
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Identification of Risk Factors Associated With Postoperative Acute Kidney Injury After Esophagectomy for Esophageal Cancer. / Konda, Prameela; Ai, Di; Guerra, Carlos E.; Rodriguez-Restrepo, Andrea; Mehran, Reza J.; Rice, David; Hofstetter, Wayne; Heir, Jagtar; Kwater, Peter; Gottumukkala, Vijaya; Hernandez, Mike; Cata, Juan P.

In: Journal of Cardiothoracic and Vascular Anesthesia, 2016.

Research output: Contribution to journalArticle

Konda, P, Ai, D, Guerra, CE, Rodriguez-Restrepo, A, Mehran, RJ, Rice, D, Hofstetter, W, Heir, J, Kwater, P, Gottumukkala, V, Hernandez, M & Cata, JP 2016, 'Identification of Risk Factors Associated With Postoperative Acute Kidney Injury After Esophagectomy for Esophageal Cancer', Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2016.07.030
Konda, Prameela ; Ai, Di ; Guerra, Carlos E. ; Rodriguez-Restrepo, Andrea ; Mehran, Reza J. ; Rice, David ; Hofstetter, Wayne ; Heir, Jagtar ; Kwater, Peter ; Gottumukkala, Vijaya ; Hernandez, Mike ; Cata, Juan P. / Identification of Risk Factors Associated With Postoperative Acute Kidney Injury After Esophagectomy for Esophageal Cancer. In: Journal of Cardiothoracic and Vascular Anesthesia. 2016.
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AU - Mehran, Reza J.

AU - Rice, David

AU - Hofstetter, Wayne

AU - Heir, Jagtar

AU - Kwater, Peter

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AU - Hernandez, Mike

AU - Cata, Juan P.

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AB - Objective: To identify risks factors associated with acute kidney injury (AKI) after esophageal cancer surgery. Design: This was a retrospective study. Setting: Single academic center. Participants: Subjects with non-metastatic esophageal cancer. Patients were excluded if they were younger than 18 years and had missing data. Measurements and Main Results: Primary outcome of the study was AKI according to AKI Network criteria. Demographic and perioperative variables were compared in patients with and without AKI. A multivariate Cox proportional model was used to assess the association between perioperative variables and AKI; p<0.05 was considered statistically significant. AKI was found in 107 (11.9%) of the 898 patients included in the study. The multivariate analysis also showed that BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), number of comorbidities (OR 1.52, 95% CI 1.20-1.93, p = 0.001), and preoperative creatinine concentrations (OR 2.37, 95% CI 1.14-4.92, p = 0.02) were independent predictors for AKI. The use of dexamethasone was associated with a reduced risk for AKI. Conclusions: In support of previous reports in the literature, the authors found that AKI was not an uncommon complication after esophageal surgery. Obesity, cardiovascular comorbidities, and high preoperative concentrations were predictors of AKI. Dexamethasone administration during surgery appeared to have a protective effect. This finding opens an opportunity to further study in a randomized controlled trial the efficacy of dexamethasone in the prevention of AKI.

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