Abstract
INTRODUCTION AND OBJECTIVES: Renal cell carcinoma (RCC) patients treated with radical (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI). We sought to investigate the incidence, trends and predictors of postoperative AKI in a large cohort of RCC patients treated with RN or PN. METHODS: Between January 1998 and December 2010, patients who underwent RN or PN for RCC were identified within the Nationwide Inpatient Sample. Incidence and temporal trends of AKI were analyzed. Association between AKI and in-hospital complications, mortality, length of stay and charges were evaluated using logistic regression models adjusted for clustering. Finally, predictors of AKI were identified using multivariable logistic regression analysis. RESULTS: Overall, 253,222 (78.1%) and 71,176 (21.9%) patients respectively underwent RN and PN. Of these, 17,828 (5.5%) experienced AKI. Incidence of AKI following RN/PN significantly increased over the period (estimated annual percentage change [EAPC]1⁄416.6% [17.7-18.8], p<0.001). Although higher overall incidence of AKI was observed after RN compared to PN (RN: 0.38/ 100,000 vs. PN: 0.09/100,000), the rate of increase in AKI over time was greater following PN compared to RN (RN: EAPC1⁄415.5% [16.817.9]; PN: EAPC1⁄419.0% [22.2-25.5], p<0.001) following PN. Incidence of any complication, mortality, prolonged hospital stay and excessive hospital costs were significantly greater in patients who experienced AKI, irrespective of the procedure (RN or PN) [all p<0.001]. Predictors of AKI after RN/PN included older age, higher comorbid status, higher chronic kidney disease stage and surgery at urban hospitals (all p<0.05). CONCLUSIONS: There is rising incidence of AKI after RN and PN. Increasing awareness of AKI incidence, identification of patients at risk prior to surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, and long-term renal functional follow-up are warranted in these patients to provide improved outcomes and reduce costs.
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