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Kidney Week

Abstract: TH-PO073

Partial Nephrectomy Is Associated with Increased Risk of AKI Compared to Radical Nephrectomy for Renal Cell Cancer

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Arora, Pradeep, VAMC, Buffalo, New York, United States
  • Lohr, James W., VAMC, Buffalo, New York, United States
  • Gajdos, Csaba, VAMC, Buffalo, New York, United States
  • Darwish, Oussama, VAMC, Buffalo, New York, United States
  • Dosluoglu, Hasan H., VAMC, Buffalo, New York, United States
  • Pourafkari, Leili, VAMC, Buffalo, New York, United States
  • Nader, Nader D., VAMC, Buffalo, New York, United States
Background


Acute kidney injury (AKI) is a common complication after major surgery including partial (PN) or radical nephrectomy (RN).

Methods

We evaluated if nephron-sparing surgery is associated with lower incidence of acute kidney injury (AKI). We used data from the national surgical quality improvement program (NSQIP) from Jan 2005 to Dec 2013. The primary endpoint was the occurrence of AKI as defined as over 200% increase in serum creatinine within 72 hours after surgery which is coded by the NSQIP. The main secondary endpoint was the occurrence of progressive kidney failure (PKF) as defined as a need for renal replacement therapy during the course of hospital stay or within 30 days of surgery. In order to identify the confounding variables for the occurrence of AKI and PKF, initially univariate analyses were performed and those factors and covariates which had a trend of significance (P<0.10) were included in multivariable binary logistic regression model. Propensity weighted analyses were then performed between the PN and RN groups for the occurrence of AKI and PKF, using confounding factors and covariates which were significant contributors of AKI and PKF.

Results

There were more male patients in both groups and the RN patients were older. PN patients had lower preoperative weight. Patients who underwent RN had higher prevalence of hypertension, CAD, CHF, dyspnea on exertion, dependent functional status, CKD as defined by eGFR <60 ml/min/1.73m2, disseminated neoplastic disease, significant weight loss of history of bleeding episodes. PN patients had higher serum hematocrit, but lower serum creatinine values. AKI was observed in a total of 143 patients. Multivariable analysis showed increasing age, female gender, eGFR <60 ml/min/1.73m2 and increased operative times were significantly associated with increased risk of AKI.
Post-operative progressive renal failure, occurred in 149 patients. In multivariable analysis only age, sex, GFR weight loss serum albumin and operative time were significant. Propensity analysis showed increased risk of AKI with PN compared to RN (OR: 1.683 (95% CI;1.073-3.181). PN also had a trend in increasing the risk of postoperative progressive kidney failure (OR: 1.683(95% CI:0.980-2.229)

Conclusion

PN was associated with increased risk of AKI.