Perioperative Acute Kidney Injury Research Articles

Predictors of acute kidney injury after percutaneous nephrolithotomy in adult patients: prospective observational study.

To assess the frequency and the predictive factors of Acute Kidney injury (AKI) in patients undergoing percutaneous nephrolithotomy (PNL). A prospective observational work. Demographic, preoperative laboratory data, stone characteristics, and intraoperative and postoperative data were gathered. Perioperative AKI had been defined as an elevation in serum creatinine by ≥ 0.3 mg/dl within 48h, or ≥ 1.5 times baseline, or urine volume less than 0.5ml/ kg/hour for 6hours. A multivariate logistic regression analysis was performed to determine the predictive factors of AKI. ROC curves were utilized to determine the cutoff values of the risk variables. P-values were deemed statistically significant when they were less than 0.05. A total of 418 participants had been involved. The frequency of AKI was 13.9, and 17.2% of patients with AKI developed CKD. The risk factors were age > 46.5 years, smoking, BMI > 28.5 kg/m2, hypertension, diabetes, utilization of angiotensin-converting enzyme inhibitors (ACEI), haemoglobin < 10.8 gm/dl, baseline creatinine > 1.41 mg/dl, eGFR < 65.2 ml/min./1.73 m2, serum uric acid > 5.2 mg/dl, stone volume > 1748 mm3, large tract size, long operative time, and intra-operative bleeding. Patients with AKI had a notably extended duration of hospitalization (3.2 days ± 0.45 vs 2.1 ± 0.42, p < 0.001). Perioperative AKI occurred in 13.9% of individuals undergoing PNL. Identification and optimization of the risk factors and meticulous technique during PNL procedures should be attempted to decrease the risk of AKI.

Pregnancy in Liver and Kidney Female Recipient: A Case Report

Deterioration of kidney function after orthotopic liver transplantation is a common complication. It may occur due to perioperative acute kidney injury (AKI) and pre-existing or developing chronic kidney disease (CKD). AKI is described in early postoperative period in more than half of the recipients whereas the main cause of CKD is pharmacotherapy. When end-stage renal failure occurs, patients may be qualified for additional transplantations.A case report: We present a rare case of 27-year-old female who as teenager underwent two liver transplantations due to Wilson's disease. Operations were complicated by systemic infection and multiple organ failure. The kidneys did not regain their function, therefore, after 6 months of dialysis, the organ was transplanted. In total, three organ transplantations were performed. Due to the patient's willingness and good graft functions, patient started trying to conceive. Three months before successful conception, immunosuppressive therapy was changed to tacrolimus and azathioprine. Pregnancy was complicated by pregnancy induced hypertension and its course was closely monitored. Organs' functions and immunosuppressive therapy were regularly assessed. Due to the pre-eclampsia developed in the 35th week of gestation, a caesarean section was performed and she gave birth to daughter weighing 2350g (Apgar 7-7-8). Women decided on breastfeeding. No obstetric complications or graft function deterioration were observed in the early postpartum period. Mother and daughter left home after 7 days of hospitalization.Conclusions: The presented clinical situation proves that successful pregnancy is possible by multi-organ transplantation recipients, without impairing the graft functions. Therefore, it requires adequate preparation and increased care.

The ability of tidal volume challenge test to predict early post-operative acute kidney injury and intra-operative hypotension in laparoscopic abdominal surgeries

ABSTRACT Background Improper management and late detection of complications, especially peri-operative acute kidney injury (AKI), could result in higher morbidity and mortality rates. This work was aimed at confirming the tidal volume challenge (TVC) test’s predictability while performing laparoscopic abdominal surgery for early postoperative AKI and intra-operative hypotension. Methods Our prospective observational study involved 70 cases whose age ranged between 18 and 65 years, American Society of Anesthesiologists (ASA) I and ASA II going through general anesthesia (GA) for laparoscopic abdominal elective surgery. Patients went through a categorization into AKI or Non-AKI according to the worst Kidney Disease: Improving Global Outcomes (KDIGO) classification according to serum creatinine and urine output that are measured at 0, 24 and 48h. Results TVC exhibited significant correlation with the AKI development with the OR of 2.3, 95% CI, p = 0.052, while the exposure index was deemed to be an AKI development risk factor with the OR of 1.0, 95% CI, p = 0.034. However, baseline neutrophil gelatinase-associated lipocalin in urine (UNGAL) showed insignificant association with the AKI development with the OR 1.04 and p = 0.366. The relationship between TVC and hypotension frequency was estimated using linear regression. The regression showed that there exists a positive significant relation between these two parameters; as hypotension frequency increases, TVC increases as well with a coefficient estimate of 0.5. Conclusions AKI represents complication after laparoscopic abdominal surgery. To avoid peri-operative renal impairment, the limiting exposure index should be considered. Our work introduces the TVC test for AKI prediction in laparoscopic abdominal surgeries.

Association of perioperative acute kidney injury with oncological outcomes in patients who undergo radical cystectomy: A multicenter retrospective study.

660 Background: Acute kidney injury (AKI) is a frequent complication in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy (RC). Previous studies have reported that AKI during cancer treatment was associated with poor oncological outcomes in several malignancies. Moreover, we previously have reported the negative impact of neoadjuvant chemotherapy-induced AKI on oncological outcomes in patients with MIBC. However, the impact of perioperative AKI on oncological outcomes in patients who undergo RC remains unclear. Methods: This multi-institutional retrospective study included 798 patients with MIBC who underwent RC. AKI was defined according to the KDIGO criteria. Stage 1 AKI was diagnosed with an increase in serum creatinine by just 0.3 mg/dL. Patients were divided into two groups: patients who developed AKI after RC (AKI group) and patients who did not (non-AKI group). Multivariable Cox-proportional hazards regression analyses were performed to evaluate the impact of perioperative AKI on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results: The median age and follow-up period were 70 years and 64 months, respectively. Of the 798 patients, 408 (51%) developed AKI after RC. Approximately 73% AKI were stage 1 AKI. RFS, CSS, and OS in the AKI group were significantly shorter than those in the non-AKI group ( P = 0.003, P = 0.035, and P &lt; 0.001, respectively). After adjustment for confounding variables, AKI was significantly associated with shorter RFS (hazard ratio [HR] 1.357, P = 0.019), CSS (HR 1.345, P = 0.042), and OS (HR 1.344, P = 0.009). Conclusions: Perioperative AKI was associated with poor oncological outcomes in patients with MIBC who underwent RC. [Table: see text]

Development and Validation of a Novel Nomogram for Predicting Perioperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting Surgery

Background: The aim of this work was to create a novel model for predicting acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCABG). Methods: The individuals who underwent OPCABG were randomly separated into a derivation group and a validation group, at a 7:3 ratio. The primary outcome was AKI under the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. To optimize feature selection and construct a nomogram, both least absolute shrinkage and selection operator regression (LASSO) and logistic regression analysis were utilized. The nomogram was assessed in various ways: with the C-index, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA). Results: The use of an intra-aortic balloon pump (IABP), systolic blood pressure, smoking and baseline serum creatinine were identified as independent impact factors. The C-index of the nomogram was 0.733 (95% confidence interval (CI) = 0.669–0.791) and 0.786 (95% CI = 0.693–0.878) in the training and validation groups, respectively. The area under the curve (AUC) of the internal validation was 0.715 using bootstrapping with 1000 replicates. The calibration plot revealed that the predicted outcomes aligned well with the observations. DCA and CICA suggested that the model had clinical benefit. Conclusion: The nomogram that relied on clinical characteristics proved to be a dependable instrument to predict AKI after OPCABG. This model is conveniently applicable in clinical settings and will be a valuable resource for assessing timely medical measures to mitigate risk.

Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study.

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine-postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87-0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.

Peri-operative acute kidney injury in dogs undergoing desexing surgery

Peri-operative acute kidney injury in dogs undergoing desexing surgery

Risk factors, criteria and biomarkers of acute kidney injury in the perioperative period

It is becoming increasingly important to prevent complications of surgical treatment, including perioperative acute kidney injury due to prolongation of life expectancy and age-related multicomorbidity. The objective was to review the recommendations of the expert groups and the studу results on risk factors, criteria and biomarkers of perioperative acute kidney injury.Materials and methods. Reports on search results for the last 15 years as of May 15, 2023 in the eLibrary, PubMed databases for the keywords «acute kidney injury», «biomarker», «perioperative period». The inclusion of reports in the review and their evaluation are based on the authors consensus. Results. In the perioperative period, acute kidney injury without a decrease in diuresis and/or an increase in serum creatinine levels up to a certain time may occur. This condition, which varies in causes and mechanisms of development, is potentially reversible with timely detection and treatment. The study of both biomarkers that surpass creatinine and diuresis in the timing and accuracy of detecting kidney damage/dysfunction, as well as tools for a comprehensive assessment and risk stratification of perioperative acute kidney injury, have not yet been completed with evidence-based conclusions. Conclusion. The strategy of using laboratory biomarkers in combination with the clinical context and risk factors for the prevention, diagnosis and treatment of subclinical acute kidney injury of various origins, supported by the Acute Disease Quality Initiative (2020), could be implemented based on additional evidence from future clinical studies.

Hyperoxia Increases Kidney Injury During Renal Ischemia and Reperfusion in Mice.

Renal ischemia and reperfusion (IR) contribute to perioperative acute kidney injury, and oxygen is a key regulator of this process. We hypothesized that oxygen administration during surgery and renal IR would impact postoperative kidney function and injury in mice. Mice were anesthetized, intubated, and mechanically ventilated with a fraction of inspired oxygen (F io2 ) 0.10 (hypoxia), 0.21 (normoxia), 0.60 (moderate hyperoxia), or 1.00 (severe hyperoxia) during 67 minutes of renal IR or sham IR surgery. Additional mice were treated before IR or sham IR surgery with 50 mg/kg tempol, a superoxide scavenger. At 24 hours, mice were sacrificed, and blood and kidney collected. We assessed and compared kidney function and injury across groups by measuring blood urea nitrogen (BUN, primary end point), renal histological injury, renal expression of neutrophil gelatinase-associated lipocalin (NGAL), and renal heme oxygenase 1 ( Ho-1 ), peroxisome proliferator-activated receptor gamma coactivator 1-α ( Pgc1-α ), and glutathione peroxidase 4 ( Gpx-4 ) transcripts, to explore potential mechanisms of any effect of oxygen. Hyperoxia and hypoxia during renal IR surgery decreased renal function and increased kidney injury compared to normoxia. Baseline median (interquartile range) BUN was 22.2 mg/dL (18.4-26.0), and 24 hours after IR surgery, BUN was 17.5 mg/dL (95% confidence interval [CI], 1.3-38.4; P = .034) higher in moderate hyperoxia-treated animals, 51.8 mg/dL (95% CI, 24.9-74.8; P < .001) higher in severe hyperoxia-treated animals, and 64.9 mg/dL (95% CI, 41.2-80.3; P < .001) higher in hypoxia-treated animals compared to animals treated with normoxia ( P < .001, overall effect of hyperoxia). Hyperoxia-induced injury, but not hypoxia-induced injury, was attenuated by pretreatment with tempol. Histological injury scores, renal NGAL staining, and renal transcription of Ho-1 and suppression of Pgc1- α followed the same pattern as BUN, in relation to the effects of oxygen treatment. In this controlled preclinical study of oxygen treatment during renal IR surgery, hyperoxia and hypoxia impaired renal function, increased renal injury, and impacted expression of genes that affect mitochondrial biogenesis and antioxidant response. These results might have implications for patients during surgery when high concentrations of oxygen are frequently administered, especially in cases involving renal IR.

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes.

Perioperative acute kidney injury (AKI) is associated with poor patient outcomes. The epidemiology of perioperative AKI is characterized in children and to a lesser extent in neonates with cardiac disease. We hypothesized that the prevalence of noncardiac perioperative AKI in neonates is higher than in older children. We also hypothesized that certain neonatal characteristics and comorbidities increase the risk of perioperative AKI and hospital mortality. We aimed to characterize the epidemiology and risk factors of perioperative AKI in neonates undergoing noncardiac surgeries and outline the associated mortality risk factors. We performed a retrospective study of neonates ≤28 days old who underwent inpatient noncardiac surgery in 46 U.S. children's hospitals participating in the Pediatric Hospital Information System between 2016 and 2021. AKI was evaluated throughout the surgical admission encounter. AKI was defined using the International Classification of Diseases (ICD) versions 9 and 10 codes. Comorbid risk factors are chronic and longstanding diagnoses and were selected using ICD-9 and ICD-10 diagnostic and procedure codes. Perioperative AKI occurred in 10% of neonates undergoing noncardiac surgeries. Comorbidities associated with high risk of perioperative AKI included metabolic, hematologic/immunologic, cardiovascular, and renal disorders. The relative risk of mortality in perioperative AKI was highest in infants with low birthweight (relative risk = 1.49, 1.14-1.94) and those with hematologic (1.46, 1.12-1.90), renal (1.24, 1.01-1.52), and respiratory comorbidities (1.35, 1.09-1.67). Perioperative AKI is common in neonates undergoing noncardiac surgeries. Infants with high-risk comorbidity profiles for the development of perioperative AKI and mortality may benefit from close surveillance of their kidney function in the perioperative period. Although retrospective, the findings of our study could inform clinicians to tailor neonatal perioperative kidney care to improve short- and long-term outcomes. · AKI is common in neonates undergoing noncardiac surgeries.. · Extremely preterm and very low birth weight neonates have the highest rates of perioperative AKI.. · Renal, hematologic, and respiratory comorbidities increase mortality risk in neonates with perioperative AKI..

Relationship between ideal cardiovascular health score and perioperative acute kidney injury: A case-control study.

Maintaining ideal cardiovascular health scores (CHS) may indirectly contribute to reducing the risk of perioperative acute kidney injury (AKI), which has never been explored previously. In this study, we aimed to explore the relationship between CHS and AKI and provide new ideas for AKI prevention and treatment. We examined the effects of CHS on the occurrence of AKI among 2783 participants from the Kailuan study, who received general anesthesia during noncardiac surgery from 2016 to 2020. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for AKI were calculated by using the logistic regression. Among 2783 participants 187 were diagnosed with perioperative AKI. We found an inverse relationship between the CHS scores and the risk of AKI. Participants with CHS score ≥ 10 had 57% decreased risk of AKI (OR = 0.43, 95% CI = 0.23, 0.79), compared with participants with CHS score ≤ 7, especially in men (OR = 0.39, 95% CI: 0.20, 0.76). In addition, participants who never smoked, exercised frequently, and had normal blood pressure had decreased risk of AKI, with corresponding ORs (95% CIs) of 0.66 (0.47, 0.91), 0.73 (0.60, 0.92), and 0.46 (0.28, 0.75), respectively. CHS was strongly associated with the risk of perioperative AKI, and higher CHS scores were associated with a lower risk of AKI. Further research is needed to explore the long-term effects of achieving and maintaining an ideal CHS on AKI risk.

Perioperative Acute Kidney Injury

Perioperative Acute Kidney Injury

Daño renal asociado al trasplante hepático

IntroductionKidney injury associated with paediatric liver transplantation (LT) is common, but its evaluation is challenging. Our aim was to analyse the presence of perioperative acute kidney injury (AKI) and study the prevalence of chronic kidney disease (CKD) using different glomerular filtration rate (GFR) estimation formulas. MethodsWe conducted a cross-sectional study in a cohort of children aged less than 18years with a history of LT followed up for 5.42years. We estimated the GFR using the creatinine-based Schwartz bedside formula (2009), the cystatin C-based Caucasian Asian Pediatric and Adult cohort (CAPA) equation and the combined full-age spectrum (FAS) formula as modified by Pottel. We analysed the agreement between them using the Bland-Altman method and the kappa statistic. We measured the albumin level in urine, the urine volume adjusted to 100mL of GFR and blood pressure. We performed univariate and multivariate analyses of the risk factors associated with CKD. ResultsThe sample included 52 patients with a median age of 9.21years. Fifteen (28.8%) had AKI. Five (10%) had CKD and the only associated risk factor was acute liver failure at the time of LT (odds ratio, 8.57; P=.04). There was poor agreement between the different estimation formulas. One patient was classified as having CKD with the Schwartz formula compared to four patients with the CAPA and the Pottel combined FAS formulas. Up to 42% of children without CKD had some positive marker of kidney injury. ConclusionsThe exclusive use of the 2009 Schwartz bedside formula to estimate GFR may lead to underdiagnosis of CKD in children post LT. Other markers of kidney injury are common, and their detection may help prevent the progression of CKD.

Kidney injury associated with liver transplantation

IntroductionKidney injury associated with paediatric liver transplantation (LT) is common, but its evaluation is challenging. Our aim was to analyse the presence of perioperative acute kidney injury (AKI) and study the prevalence of chronic kidney disease (CKD) using different glomerular filtration rate (GFR) estimation formulas. MethodsWe conducted a cross-sectional study in a cohort of children aged less than 18 years with a history of LT followed up for 5.42 years. We estimated the GFR using the creatinine-based Schwartz bedside formula (2009), the cystatin C-based Caucasian Asian Pediatric and Adult cohort (CAPA) equation and the combined Full-Age Spectrum (FAS) formula as modified by Pottel. We analysed the agreement between them using the Bland–Altman method and the kappa statistic. We measured the albumin level in urine, the urine volume adjusted to 100 mL of GFR and blood pressure. We performed univariate and multivariate analyses of the risk factors associated with CKD. ResultsThe sample included 52 patients with a median age of 9.21 years. Fifteen (28.8%) had AKI. Five (10%) had CKD and the only associated risk factor was acute liver failure at the time of LT (odds ratio, 8.57; P = 0.04). There was poor agreement between the different estimation formulas. One patient was classified as having CKD with the Schwartz formula compared to four patients with the CAPA and the Pottel combined FAS formulas. Up to 42% of children without CKD had some positive marker of kidney injury. ConclusionsThe exclusive use of the 2009 Schwartz bedside formula to estimate GFR may lead to underdiagnosis of CKD in children post LT. Other markers of kidney injury are common, and their detection may help prevent the progression of CKD.

Perioperative acute kidney injury in surgical treatment of renal cancer: pathogenesis, therapy of early and late complications

The development of acute renal injury is due to a number of factors both on the part of the patient (age, concomitant pathology, objective status) and the oncological process (stage of the disease, localization, volume of surgical intervention, access, etc.). Acute renal injury in patients with kidney cancer after surgical treatment may be accompanied by the development of early (hyperhydration, electrolyte balance disorders, hyperkalemia, acid‑base condition disorders, uremic intoxication) and late chronic kidney disease complications. The incidence of these complications increases with an increase in the volume of kidney resection, as a result of which it is important to take into account risk factors, timely diagnosis of the degree of kidney damage and medical measures aimed at restoring kidney function. Currently, the possibility of using various molecules as early markers of kidney damage, which help not only assess the presence of kidney damage, but also localize it, is being studied. For example, albumin, serum cystatin C, alpha 1‑microglobulin, P2‑microglobulin – markers of glomerular damage, NGAL, KIM‑1; L‑FABP, urine cystatin‑C, IL‑18 – reflect damage to the proximal tubule, GST, NGAL – distal tubule, calibindin D28 ‑ characterizes damage to the collecting duct, osteopontin, NHE‑3 – are associated with damage to the loop of Henle. Measures of a curative and preventive nature (infusion therapy, anti‑ischemic protection, modulation of ferroptosis, renal replacement therapy), as well as dynamic monitoring of the main biomarkers of renal damage are aimed at preventing the persistence of the pathological process with a possible outcome into chronic kidney disease, which is especially undesirable in patients with single kidney cancer. The main directions of medical and preventive measures in patients with acute kidney injury should be considered: 1) the fastest possible elimination or minimization of the effect of tumor tissue; 2) control and correction of life‑threatening complications of renal dysfunction (hyperhydration, electrolyte balance disorders (hyperkalemia), acid‑base state, uremic intoxication). Methods of anti‑ischemic protection include a number of surgical techniques aimed at 1) minimizing ischemia time, 2) reducing the intensity of volatile metabolic processes in the kidney, 3) training renal parenchyma for hypoxic conditions (receiving ischemic preconditioning).Duration of renal ischemia represents an important modifiable factor affecting early and distant renal function in surgically exposed patients. The article analyzes modern scientific data on the problem of postoperative acute kidney injury in renal cancer surgery.

Renal transplant recipients undergoing endovascular abdominal aortic aneurysm repair have increased risk of perioperative acute kidney injury but no difference in late mortality: Presented at the 2022 Vascular Annual Meeting of the Society for Vascular Surgery; Boston, Massachusetts, June 15-18, 2022.

Objective: Renal transplant is associated with substantial survival advantage in patients with end-stage renal disease. However, little is known about the outcomes of renal transplant recipients (RTRs) after endovascular abdominal aortic aneurysm repair (EVAR). This study aimed to study the effect of renal transplant on perioperative outcomes and long-term survival after elective infrarenal EVAR.

MP58-16 SIGNIFICANCE OF GLUCOSE CONTROL FOR PERIOPERATIVE AND LONG-TERM RENAL FUNCTIONS AFTER NEPHRON-SPARING SURGERY FOR RENAL CANCER IN PATIENTS WITH DIABETES

You have accessJournal of UrologyCME1 Apr 2023MP58-16 SIGNIFICANCE OF GLUCOSE CONTROL FOR PERIOPERATIVE AND LONG-TERM RENAL FUNCTIONS AFTER NEPHRON-SPARING SURGERY FOR RENAL CANCER IN PATIENTS WITH DIABETES Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Seong Hyeon Yu, Ho Seok Chung, Kyung Jin Oh, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, and Eu Chang Hwang Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Seong Hyeon YuSeong Hyeon Yu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Sun-Ouck KimSun-Ouck Kim More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Dong Deuk KwonDong Deuk Kwon More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , and Eu Chang HwangEu Chang Hwang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS). METHODS: The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5–1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to <60 mL/min/1.73 m2. RESULTS: Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariate analyses revealed that female gender (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.16–0.91, p=0.029), uncontrolled DM (OR=2.63, 95% CI: 1.05–6.60, p=0.039), and intermediate NePhRO score (OR=2.02, 95% CI: 1.07–3.80, p=0.03) were associated with perioperative AKI. In addition, old age (OR=1.14, 95% CI: 1.10–1.18, p<0.001) and uncontrolled DM (OR=4.57, 95% CI: 1.84–11.4, p=0.001) were associated with long-term CKD progression. CONCLUSIONS: Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e802 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Seong Hyeon Yu More articles by this author Ho Seok Chung More articles by this author Kyung Jin Oh More articles by this author Sun-Ouck Kim More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Dong Deuk Kwon More articles by this author Kwangsung Park More articles by this author Eu Chang Hwang More articles by this author Expand All Advertisement PDF downloadLoading ...

Acute kidney injury early after left ventricular assist device implantation: incidence, risk factors and clinical consequences.

Renal dysfunction or renal failure is a common complication in patients undergoing a left ventricular assist device (LVAD). Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) is the most commonly used inexpensive and easy method for the evaluation of kidney function. In studies, the development of acute kidney injury (AKI) after LVAD has generally been studied at 1, 3 months and 1 year, but there are almost no studies with 1-week data. We retrospectively analyzed the incidence of AKI, risk factors, length of stay in hospital and intensive care unit (ICU), and postoperative complications of 138 patients who underwent LVAD implantation in our center between 2012 and 2021, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the preoperative, postoperative 1st day, 2nd day, 1st week, 1st month, 3rd month and 1st year serum creatinine, eGFR and blood urea nitrogen (BUN) values. The mean age of 138 patients who underwent LVAD implantation and evaluated the development of AKI was 50.4 (±10.86) and 119 (86.2%) were males. The incidence of AKI, the need for renal replacement therapy (RRT) and dialysis after LVAD implant were respectively 25.4%, 25.3% and 12.3%. According to the KDIGO criteria, in the AKI (+) patient group, 21 (15.2%) cases were identified as stage 1, 9 (6.5%) as stage 2 and 5 (3.6%) as stage 3. The incidence of AKI was found to be high in cases with diabetes mellitus (DM), age, preoperative creatinine level ≥1.2, and eGFR ≤60 ml/min/m2. There is a statistically significant relationship between having AKI and right ventricular (RV) failure (p=0.0033). Right ventricular failure developed in 10 (28.6%) of 35 patients who developed AKI. If perioperative AKI is recognized early, the development of advanced stages of AKI and mortality can be reduced with nephroprotective measures.

Perioperative acute kidney injury: Current knowledge and the role of anaesthesiologists

Background Among the different types of perioperative organ injury, acute kidney injury (AKI) occurs frequently and is consistently associated with increased rates of mortality and mortality. Despite development of many clinical trials to assess perioperative interventions, reliable means to prevent or reverse AKI are still lacking. Objectives This narrative review discusses recent literature on modifiable risk factors, current approaches to prevention and potential directions for future research. Methods A Pubmed search with the relevant keywords was done for articles published in the last 10 years. Results New insights into preoperative identification and optimisation, intraoperative strategies, including the choice of anaesthetic, haemodynamic and fluid management, have been made, with the aim of preventing perioperative AKI. Conclusion A patient-centric multidisciplinary approach is essential to protect kidney function of patients going for surgery. Much can be done by anaesthesiologists perioperatively, to reduce the risk of development of AKI, especially in susceptible patients. There is a need for further multicentred trials to enhance the currently generic perioperative recommendations.

Insertion of a urinary catheter on admission lowers acute kidney injury incidence in patients with hip fractures.

Acute kidney injury (AKI) is a common adverse event in patients undergoing hip fracture repair surgery, increasing morbidity and mortality. Our study hypothesis was that routine insertion of a urinary catheter, on admission to the hospital or immediately before surgery, will reduce AKI incidence in hip fracture patients. Determined by alternating days of admission, a urinary catheter was inserted routinely on admission (catheter group) or as needed (non-catheter group) in 250 consecutive patients who presented with a hip fracture to our emergency department. The incidence of AKI according to the KDIGO criteria and morbidity and mortality were compared between the study groups. The overall incidence of AKI was 11.6% (29/250). The catheter group (N = 122) had a significantly lower rate of AKI (6.6% vs. 16% p = 0.018). At 12-month follow-up, the overall mortality was 10.8% (27/250), in-hospital 7.4% (2/27), short-term (within 30days) 7.4% (2/27), and long-term (30days to 1year) 85.8% (23/27). All in-hospital mortality occurred in the AKI group. Patients with no AKI had a better survival rate; however, the difference was not significant (p-value = 0.21). Mortality rate was lower in the catheter group but not significant (8.2% compared with 13.8% in the non-catheter group, p = 0.225). Post-operative respiratory and cardiac complications were more frequent in the AKI group (p = 0.02 and 0.043 accordingly). Insertion of a urinary catheter upon admission or before surgery lowered AKI incidence significantly. Peri-operative AKI was associated with higher rates of post-operative complications and worse survival.