Citation Information :
Milmile R, Dhakane P. Incidence and Predictors of Acute Kidney Injury in Patients Undergoing Elective Hepatic Resection for Malignant Tumors: A 3-year Prospective Observational Study. Indian J Crit Care Med 2021; 25 (4):398-404.
Background: Acute kidney injury (AKI) is common in patients undergoing major surgeries, and leads to the need for renal replacement therapy and increased morbidity, intensive care unit (ICU) and hospital length of stay (LOS), cost, and mortality. We evaluated the incidence and predictors of postoperative AKI in patients undergoing hepatic resections and their short-term outcomes.
Materials and methods: This prospective observational study was conducted over a 3-year period in 180 patients undergoing elective hepatic resections for a variety of indications. We used the Acute Kidney Injury Network criteria to determine the incidence of AKI at 72 hours. Perioperative variables contributing to the development of AKI and the short-term postoperative outcomes of patients were evaluated.
Results: Postoperative AKI occurred in 29.4% of patients. Persistent renal dysfunction was seen in five patients. Development of AKI was associated with hepatic failure (18.5 vs 5.5%, p < 0.005), prolonged ICU (2 vs 1 days, p < 0.001) and hospital LOS (11 vs 8 days, p < 0.004), and increased ICU and hospital mortality (9.6 vs 1.4%, p < 0.02). Age [OR (odds ratio) 1.033, 95% CI (confidence interval) 1.003–1.065, p = 0.03], BMI (body mass index) (OR 1.131, 95% CI 1.043–1.227, p = 0.003), and need for postoperative ventilation (OR 3.456, 95% CI 1.593–7.495, p = 0.002) were independent predictors of AKI.
Conclusion: AKI after elective hepatic resection occurred in nearly one-third of our patients. Persistent renal dysfunction was seen in five patients. Age, BMI, and need for postoperative ventilation were independent predictors of postoperative AKI. (CTRI reg. No.: CTRI/2016/06/007044).
Mehta RL, Cerda J, Burdmann EA, Tonelli M, Garcia-Garcia G, Jha V, et al. International Society of Nephrology's 0 by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015;385(9987):2616–2643. DOI: 10.1016/S0140-6736(15)60126-X.
Zhang Y, Jiang L, Wang B, Xi X. Epidemiological characteristics of and risk factors for patients with postoperative acute kidney injury: a multicenter prospective study in 30 Chinese intensive care units. Int Urol Nephrol 2018;50(7):1319–1328. DOI: 10.1007/s11255-018-1828-7.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16(11):3365–3370. DOI: 10.1681/ASN.2004090740.
Collister D, Pannu N, Ye F, James M, Hemmelgarn B, Chui B, et al. Alberta kidney disease network. Health care costs associated with AKI. Clin J Am Soc Nephrol 2017;12(11):1733–1743. DOI: 10.2215/CJN.00950117.
Raimann JG, Riella MC, Levin NW. International Society of Nephrology's 0 by 25 initiative (zero preventable deaths from acute kidney injury by 2025): focus on diagnosis of acute kidney injury in low-income countries. Clin Kidney J 2018;11(1):12–19. DOI: 10.1093/ckj/sfw134.
O’Connor ME, Kirwan CJ, Pearse RM, Prowle JR. Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med 2016;42(4):521–530. DOI: 10.1007/s00134-015-4157-7.
Dedinská I, Mikolajčík P, Skálová P, Mokáň M, Laca Ľ. Acute kidney injury after liver resection in elderly patients. BMC Nephrol 2019;20(1):272. DOI: 10.1186/s12882-019-1449-0
Bredt LC, Peres LAB. Risk factors for acute kidney injury after partial hepatectomy. World J Hepatol 2017;9(18):815–822. DOI: 10.4254/wjh.v9.i18.815.
Jones DR, Lee HT. Perioperative renal protection. Best Pract Res Clin Anaesthesiol 2008 Mar;22(1):193–208. DOI: 10.1016/j.bpa.2007.08.005.
Trongtrakul K, Sawawiboon C, Wang AY, Chitsomkasem A, Limphunudom P, Kurathong S, Prommool S, et al. Acute kidney injury in critically ill surgical patients: Epidemiology, risk factors and outcomes. Nephrology (Carlton) 2019;24(1):39–46. DOI: 10.1111/nep.13192.
Tomozawa A, Ishikawa S, Shiota N, Cholvisudhi P, Makita K. Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study. Can J Anaesth 2015;62(7):753–761. DOI: 10.1007/s12630-015-0397-9.
Lim C, Audureau E, Salloum C, Levesque E, Lahat E, Merle JC, et al. Acute kidney injury following hepatectomy for hepatocellular carcinoma: incidence, risk factors and prognostic value. HPB (Oxford) 2016;18(6):540–548. DOI: 10.1016/j.hpb.2016.04.004.
Garnier J, Faucher M, Marchese U, Meillat H, Mokart D, Ewald J, et al. Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes. HPB (Oxford) 2018;20(9):865–871. DOI: 10.1016/j.hpb.2018.03.011.
Slankamenac K, Breitenstein S, Held U, Beck-Schimmer B, Puhan MA, Clavien PA. Development and validation of a prediction score for postoperative acute renal failure following liver resection. Ann Surg 2009;250(5):720–728. DOI: 10.1097/SLA.0b013e3181bdd840.
Cho E, Kim SC, Kim MG, Jo SK, Cho WY, Kim HK. The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study. BMC Nephrol 2014;15:169. DOI: 10.1186/1471-2369-15-169.
Mathur AK, Ghaferi AA, Osborne NH, Pawlik TM, Campbell DA, Englesbe MJ, et al. Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg 2010;14(8):1285–1291. DOI: 10.1007/s11605-010-1232-9.
Zou Z, Zhuang Y, Liu L, Shen B, Xu J, Luo Z, et al. Role of body mass index in acute kidney injury patients after cardiac surgery. Cardiorenal Med 2017;8(1):9–17. DOI: 10.1159/000477824.
Kelz RR, Reinke CE, Zubizarreta JR, Wang M, Saynisch P, Even-Shoshan O, et al. Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study. Ann Surg 2013;258(2):359–363. DOI: 10.1097/SLA.0b013e31829654f3.
Danziger J, Chen KP, Lee J, Feng M, Mark RG, Celi LA, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med 2016;44(2):328–334. DOI: 10.1097/CCM.0000000000001398.
Soto GJ, Frank AJ, Christiani DC, Gong MN. Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med 2012;40(9):2601–2608. DOI: 10.1097/CCM.0b013e3182591ed9.
Billings FT 4th, Pretorius M, Schildcrout JS, Mercaldo ND, Byrne JG, Ikizler TA, et al. Obesity and oxidative stress predict AKI after cardiac surgery. J Am Soc Nephrol 2012;23(7):1221–1228. DOI: 10.1681/ASN.2011090940.
Schiffl H, Lang SM. Obesity, acute kidney injury and outcome of critical illness. Int Urol Nephrol 2017;49(3):461–466. DOI: 10.1007/s11255-016-1451-4.
Nehus E. Obesity and chronic kidney disease. Curr Opin Pediatr 2018;30(2):241–246. DOI: 10.1097/MOP.0000000000000586.
Brito DJ, Nina VJ, Nina RV, Figueiredo Neto JA, Oliveira MI, Salgado JV, et al. Prevalence and risk factors for acute renal failure in the postoperative of coronary artery bypass grafting. Rev Bras Cir Cardiovasc 2009;24(3):297–304. DOI: 10.1590/s0102-76382009000400007.
Heringlake M, Nowak Y, Schön J, Trautmann J, Berggreen AE, Charitos EI, et al. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients. Crit Care 2014;18(5):547. DOI: 10.1186/s13054-014-0547-4.
van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care 2013;17(3):R98. DOI: 10.1186/cc12743.
Koyner JL, Murray PT. Mechanical ventilation and the kidney. Blood Purif 2010;29(1):52–68. DOI: 10.1159/000259585.
Kambakamba P, Slankamenac K, Tschuor C, Kron P, Wirsching A, Maurer K, et al. Epidural analgesia and perioperative kidney function after major liver resection. Br J Surg 2015;102(7):805–812. DOI: 10.1002/bjs.9810.
Ham SY, Kim EJ, Kim TH, Koo BN. Comparison of perioperative renal function between epidural and intravenous patient-controlled analgesia after living-donor hepatectomy: a retrospective study. Transplant Proc 2018;50(5):1365–1371. DOI: 10.1016/j.transproceed.2018.03.006.
Bihorac A. Acute kidney injury in the surgical patient: recognition and attribution. Nephron 2015;131(2):118–122. DOI: 10.1159/000439387.
Grams ME, Sang Y, Coresh J, Ballew S, Matsushita K, Molnar MZ, et al. Acute kidney injury after major surgery: a retrospective analysis of veterans health administration data. Am J Kidney Dis 2016;67(6):872–880. DOI: 10.1053/j.ajkd.2015.07.022.