Abstract
Postoperative acute kidney injury (AKI) is still a concern in partial nephrectomy (PN), even with the development of minimally invasive technique. We aimed to compare AKI incidence between patients with and without diabetes mellitus (DM) and to determine the predictive factors for postoperative AKI. This case-matched retrospective study included 884 patients with preoperative creatinine levels ≤1.4 mg/dL who underwent laparoscopic or robot-assisted laparoscopic PN between December 2005 and May 2018. Propensity score matching was employed to match patients with and without DM in a 1:3 ratio (101 and 303 patients, respectively). Of 884 patients, 20.4% had postoperative AKI. After propensity score matching, the incidence of postoperative AKI in DM and non-DM patients was 30.7% and 14.9%, respectively (P < 0.001). In multivariate analysis, male sex and warm ischemia time (WIT) >25 min were significantly associated with postoperative AKI in patients with and without DM. In patients with DM, hemoglobin A1c (HbA1c) >7% was a predictive factor for AKI, odds ratio (OR) = 4.59 (95% CI, 1.47–14.36). In conclusion, DM increased the risk of AKI after minimally invasive PN; male sex, longer WIT, and elevated HbA1c were independent risk factors for AKI in patients with DM.
Highlights
Partial nephrectomy (PN) is the current gold standard treatment for small, localized renal tumors owing to reduced risk of acute and chronic kidney dysfunction compared with radical nephrectomy [1,2]
D(SMD, D).iaNbeotessmigelnlitiufis;ceaGnFtR,deisfftimerateend cgelosmweruelarrefiltration rate; Pre-op—preoopbesraetirvveleyd; PObDe0t—wpeoestnopperaattiiveendtasy 0w(iimthmeadniadtelywafittehr tohue otpDeraMtiona)t; PeOaDc1h—tpiomstoepepraotiivnetd.ayD1M—P,ODDi2a, pboesttoepsermativeelldiatyu2s.; eGFR, estimated glomerular filtration rate; Pre-op—preoperatively; POD0—postoperative day 0; POD1—postoperative day 1—POD2, postoperative day 2. This is the first retrospective case-matched study to clarify whether patients with Diabetes mellitus (DM) have an increased risk of acute kidney injury (AKI) and evaluate risk factors for AKI in patients with and without DM after minimally invasive PN
The main findings were as follows: (1) DM was a strong predictive factor for AKI after minimally invasive PN. (2) The incidence rate of postoperative AKI was significantly higher in patients with DM than in those without DM, even after adjustment for other factors
Summary
Partial nephrectomy (PN) is the current gold standard treatment for small, localized renal tumors owing to reduced risk of acute and chronic kidney dysfunction compared with radical nephrectomy [1,2]. In case of robot assisted PN, the incidence of postoperative AKI was reported as 24%–27% [5,6]. Patients with DM are at an increased risk of acute kidney dysfunction throughout their lifetime [8]. Previous studies investigating risk factors for AKI in all patients who underwent PN did not distinguish the open technique from the minimally invasive approach [3,4,12,13,14,15]. No study has determined whether patients with DM have an increased risk of AKI after minimally invasive PN.
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