Perioperative factors associated with acute kidney injury after partial nephrectomy

S. Rajan, Rovnat Babazade, S. R. Govindarajan, R. Pal, J. You, E. J. Mascha, A. Khanna, M. Yang, F. D. Marcano, A. K. Singh, J. Kaouk, A. Turan

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background. Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. Methods. The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. Results. A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min-1 1.73 m-2 for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min-1 1.73 m-2 lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min-1 1.73 m-2 for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min-1 1.73 m-2 for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min-1 1.73 m-2 lower for patients who received warm ischemia as compared to cold ischemia. Conclusion. Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalBritish Journal of Anaesthesia
Volume116
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Nephrectomy
Glomerular Filtration Rate
Acute Kidney Injury
Warm Ischemia
Kidney
Hypertension
Cold Ischemia
Wounds and Injuries
Operative Time
Postoperative Period
Linear Models
Creatinine
Ischemia
Outcome Assessment (Health Care)
Serum

Keywords

  • acute kidney injury
  • partial nephrectomy
  • perioperative factors

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Perioperative factors associated with acute kidney injury after partial nephrectomy. / Rajan, S.; Babazade, Rovnat; Govindarajan, S. R.; Pal, R.; You, J.; Mascha, E. J.; Khanna, A.; Yang, M.; Marcano, F. D.; Singh, A. K.; Kaouk, J.; Turan, A.

In: British Journal of Anaesthesia, Vol. 116, No. 1, 01.01.2016, p. 70-76.

Research output: Contribution to journalArticle

Rajan, S, Babazade, R, Govindarajan, SR, Pal, R, You, J, Mascha, EJ, Khanna, A, Yang, M, Marcano, FD, Singh, AK, Kaouk, J & Turan, A 2016, 'Perioperative factors associated with acute kidney injury after partial nephrectomy', British Journal of Anaesthesia, vol. 116, no. 1, pp. 70-76. https://doi.org/10.1093/bja/aev416
Rajan, S. ; Babazade, Rovnat ; Govindarajan, S. R. ; Pal, R. ; You, J. ; Mascha, E. J. ; Khanna, A. ; Yang, M. ; Marcano, F. D. ; Singh, A. K. ; Kaouk, J. ; Turan, A. / Perioperative factors associated with acute kidney injury after partial nephrectomy. In: British Journal of Anaesthesia. 2016 ; Vol. 116, No. 1. pp. 70-76.
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abstract = "Background. Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. Methods. The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. Results. A total of 1187 (61{\%}) patients had no kidney injury, 647 (33{\%}) had stage I, 80 (4{\%}) had stage II, and 41 (2{\%}) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76{\%} CI 0.79-0.88) ml min-1 1.73 m-2 for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76{\%} CI: 0.13, 5.18) ml min-1 1.73 m-2 lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76{\%} CI: 0.22, 0.62) ml min-1 1.73 m-2 for a 10-minute longer in duration of procedure and decreased 2.09 (99.76{\%} CI: 1.39, 2.80) ml min-1 1.73 m-2 for a 10-minute longer in ischemia time. It was 3.53 (99.76{\%} CI: 0.83, 6.23) ml min-1 1.73 m-2 lower for patients who received warm ischemia as compared to cold ischemia. Conclusion. Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.",
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AU - Babazade, Rovnat

AU - Govindarajan, S. R.

AU - Pal, R.

AU - You, J.

AU - Mascha, E. J.

AU - Khanna, A.

AU - Yang, M.

AU - Marcano, F. D.

AU - Singh, A. K.

AU - Kaouk, J.

AU - Turan, A.

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N2 - Background. Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. Methods. The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. Results. A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min-1 1.73 m-2 for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min-1 1.73 m-2 lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min-1 1.73 m-2 for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min-1 1.73 m-2 for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min-1 1.73 m-2 lower for patients who received warm ischemia as compared to cold ischemia. Conclusion. Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.

AB - Background. Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy. Methods. The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied. Results. A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min-1 1.73 m-2 for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min-1 1.73 m-2 lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min-1 1.73 m-2 for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min-1 1.73 m-2 for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min-1 1.73 m-2 lower for patients who received warm ischemia as compared to cold ischemia. Conclusion. Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.

KW - acute kidney injury

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