80 ACUTE KIDNEY INJURY WITHIN 30 DAYS OF NEPHRECTOMY

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You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201280 ACUTE KIDNEY INJURY WITHIN 30 DAYS OF NEPHRECTOMY Brian Le, Amanda Chi, James M. Dupree, Lee Zhao, John Cashy, and Shilajit Kundu Brian LeBrian Le Chicago, IL More articles by this author , Amanda ChiAmanda Chi Chicago, IL More articles by this author , James M. DupreeJames M. Dupree Chicago, IL More articles by this author , Lee ZhaoLee Zhao Chicago, IL More articles by this author , John CashyJohn Cashy Chicago, IL More articles by this author , and Shilajit KunduShilajit Kundu Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little has been published on acute kidney injury (AKI) in the immediate postoperative period following radical (RN) and partial (PN) nephrectomy. Nevertheless, AKI carries with it significant morbidity, cost and potential mortality. Studies by Cho et al. have described post-operative acute kidney injury as a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Previous studies, reported AKI rate ranges from 1.3% in PN and 0.4% in RN (Stephenson, 2004), to 5.4% in PN (Pasticer, 2006) and 34% in RN (Cho 2011). This study aims to identify frequency of and preoperative risk factors for AKI in the nephrectomy population using a nationwide outcomes database. METHODS Using 2005 to 2009 data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), patients who underwent PN or RN without preoperative diagnosis of renal failure were identified. Patients with postoperative rise in serum creatinine of > 2mg/dl, were diagnosed with renal failure or who required new dialysis were defined as having AKI. We examined the risk factors that may contribute to AKI within 30 days of operation. Comparative analysis was conducted using Chi-square and Fischer exact tests. RESULTS 2435 PN (27.3%) or RN (72.7%) patients met inclusion criteria, 58 (2.38%) of which had AKI postoperatively (1.80% for PN vs. 2.84% for RN). Compared to the non-AKI group, the AKI group had longer operation time (218 minutes vs 183, p = 0.04), were more likely to have hypertension requiring medication (OR 2.21, p = 0.01), and have undergone percutaneous coronary intervention (OR 2.32, p = 0.04). Although statistically insignificant, AKI patients tended to have higher preoperative creatinine, (1.72 vs 1.49, p = 0.14), more blood transfused (1.26 vs 0.44, p = 0.14), longer smoking history (22 vs 14 pack years, p = 0.09), and be male (OR 1.66, p = 0.08). Other factors looked at, but not significantly associated with AKI were history of peripheral vascular disease requiring revascularization or amputation, angina within 1 month prior to surgery, previous cardiac surgery, congestive heart failure 30 days prior to surgery, and smoking within 1 year prior to surgery. CONCLUSIONS AKI within 30 days post nephrectomy is rare, occurring in 2.38% of cases. Associated factors include longer operative time, history of hypertension requiring medication, and previous percutaneous coronary intervention. Further studies are needed assess the costs and long-term ramifications of AKI. References Cho et al., 2011 : Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol. Dial. Transplant2011; 26: 3496. Google Scholar Pasticier et al., 2006 : Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. European Urology2006; 49: 485. Google Scholar Stephenson et al., 2004 : Complications of radical and partial nephrectomy in a large contemporary cohort. J Urology2004; 171: 130. Link, Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e34 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Le Chicago, IL More articles by this author Amanda Chi Chicago, IL More articles by this author James M. Dupree Chicago, IL More articles by this author Lee Zhao Chicago, IL More articles by this author John Cashy Chicago, IL More articles by this author Shilajit Kundu Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...