Abstract
Acute kidney injury (AKI) is common after gastric surgery for gastric cancer and associated with adverse outcomes. However, the impact of transient or persistent AKI on clinical outcomes after gastric surgery for gastric cancer has not been described. We performed a retrospective study of 4,886 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2012. AKI patients were classified as transient and persistent AKI based on the return of serum creatinine to the level indicating no AKI within 7 days. Our outcomes included occurrence of new-onset chronic kidney disease (CKD) and mortality 1 year after gastric surgery. AKI occurred in 638 (13.1%) after gastric surgery. Transient AKI was documented in 574 (90%). Use of diuretics and contrast agents was a common risk factor for persistent and transient AKI. Length of intensive care unit (ICU) and hospital stay, and ICU admission rate were higher in patients with transient AKI than in those without AKI. Although patients with persistent AKI had a higher new-onset CKD 1 year after gastric surgery after adjusting for multiple covariates, transient AKI was not associated with new-onset CKD. The 1-year mortality rates were significantly higher in patients with transient and persistent AKI. Not only persistent AKI but transient AKI is associated with increased risk of hospital complications and a significantly higher risk of long-term mortality than patients without AKI after gastric surgery. Moreover, persistent AKI, but not transient AKI, is associated with CKD progression at 1 year.
Highlights
Acute kidney injury (AKI) is a common complication associated with high morbidity and mortality in hospitalized patients [1]
Similar to results of previous studies, our results showed that postoperative transient AKI was a risk factor for 1-year mortality in patients with gastric cancer after adjusting for appropriate covariates
We found that patients with persistent AKI for more than 7 days had a higher risk of long-term mortality than those with transiently early recovery from AKI after gastric surgery
Summary
Acute kidney injury (AKI) is a common complication associated with high morbidity and mortality in hospitalized patients [1]. We found that 14.4% of patients with gastric cancer after gastric surgery developed postoperative AKI. Recent studies demonstrated that even transient AKI is associated with increased morbidity or mortality in hospitalized patients [7,8,9,10,11,12]. We hypothesized that transient AKI is common and would influence the short and longterm clinical outcomes in gastric cancer patients undergoing gastric surgery. The present study aimed to assess the incidence and predictive factors of transient and persistent AKI after gastric surgery for gastric cancer, as well as to determine the association between transient or persistent AKI and progression of CKD and mortality
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