Chronic Kidney Disease Classification Predicts Short-Term Outcomes of Patients Undergoing Pancreaticoduodenectomy

Abstract

BackgroundThe impact of chronic kidney disease (CKD) on pancreaticoduodenectomy has not been well established. In this study, we investigated the effects of preoperative CKD in patients undergoing pancreaticoduodenectomy. MethodsA retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients who underwent pancreaticoduodenectomy between 2015 and 2019. The estimated glomerular filtration rate (eGFR) for each patient was calculated using the CKD-Epidemiology Collaborative (CKD-EPI) 2021 equation. Kidney function was stratified according to the Kidney Disease: Improving Global Outcomes (KDIGO) Classification: G1, normal/high function (estimated glomerular filtration rate ≥ 90 ml/min/1.73 m2); G2–G3, mild/moderate CKD (89–30 ml/min/1.73 m2); and G4–G5, severe CKD (≤ 29 ml/min/1.73 m2). The 30-day overall complications and outcomes were compared using regression models accounting for demographics and comorbidities. ResultsA total of 20,656 (55.7% men) patients were identified. Univariate analysis showed that compared to G1 patients, G2–G3 and G4–G5 had higher rates of overall complications (p < 0.001), need for readmission (p = 0.004), need for reoperation (p < 0.001), discharge to the care facility (p < 0.001), death (p < 0.001), and average length of stay (p < 0.001). On multivariable regression, G2–G3 renal function was found to be an independent risk factor for overall (1.10 [1.04–1.17], p = 0.002), pulmonary (1.23 [1.10—1.37], p < 0.001), hematologic (1.08 [1.02–1.16], p = 0.015), and renal (1.29 [1.11–1.49], p < 0.001) complications; discharge to care facility (1.10 [1.02–1.19], p = 0.045); and 30-day mortality (1.25 [1.01–1.56], p = 0.045). G4–G5 renal function was a predictor of worse outcomes for the prior variables and an independent risk factor for cardiovascular complications (2.70 [1.44–4.96], p = 0.001) and length of stay (1.32 [1.13–1.56], p < 0.001). ConclusionsThe degree of CKD was related to the overall complications and outcomes after pancreaticoduodenectomy. Therefore, the CKD classification should be strongly considered in the preoperative risk stratification of these patients.