Abstract
BackgroundAcute kidney injury (AKI) affects approximately 13% of patients undergoing major abdominal surgery, and is a common and important clinical sign of perioperative injury. The aim of our analysis was to identify risk factors for AKI in elderly patients with no known kidney disease at the time of surgery, and to evaluate their 30-day, 12-month and 5-year survival.MethodsWe performed a retrospective analysis on a group of 785 patients after liver resection to determine the incidence of complications (AKI – according to KDIGO classification, sepsis, cardiovascular and surgical complications). All patients had normal kidney function prior to surgery. We determined risk factors for the development of AKI for two groups of patients, stratified for age: patients younger than 65 years, and patients older than 65 years.ResultsThe incidence of complications was significantly higher in the group of patients older than 65 years (n = 76) than in younger patients (n = 119) (P = 0.0496). In the group of younger patients, significantly worse 30-day survival was observed for patients who developed AKI (P = 0.0004). We identified the following independent risk factors for AKI: male gender (HR 10,3834; P = 0,0238), histological identification of colorectal carcinoma metastases (HR 2,8651; P = 0,0499), surgery duration longer than 300 min (HR 6,0096; P < 0,0001), blood loss of more than 500 ml (HR 10,5857; P = 0,0012), and the need for more than 500 ml of fresh frozen plasma during surgery ml (HR 2,4878; P < 0,0317). Age was not confirmed to be an independent risk factor for AKI in our study.ConclusionApproaches to treatment should be highly individualized, with assessment of several variables. According to our findings, age should not present a contraindication for the indication of a patient for surgery.
Highlights
Acute kidney injury (AKI) affects approximately 13% of patients undergoing major abdominal surgery, and is a common and important clinical sign of perioperative injury
It is generally known that patients with compromised renal function have increased AKI risk and we tried to identify in our analysis risk patients for AKI in the input “non-risk” group of patients without reduced estimated glomerular filtration rate (eGFR) at the time of surgery
We identified the cause of resection and the type of resection performed, classified as either large resection, small resection, or radiofrequency ablation (RFA; performed when the liver could not be resected)
Summary
Acute kidney injury (AKI) affects approximately 13% of patients undergoing major abdominal surgery, and is a common and important clinical sign of perioperative injury. Systemic inflammation is already well known to cause stress or injury to endothelial, tubular and glomerular kidney cells which are very sensitive to circulating inflammatory. The clinical outcomes of such responses depend on the stage of inflammatory stress, Convincing evidence suggests that the incidence of AKI is rapidly increasing, especially among acutely ill hospitalized patients and patients undergoing major surgical procedures. This increase can partly be thanks to greater recognition of AKI, improved detection of administrative data and greater sensitivity of diagnostics and classification schemes.
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