The relationships of acute kidney injury duration and severity with long-term functional deterioration following partial nephrectomy

• Published in: International urology and nephrology Vol. 54; no. 7; pp. 1623 - 1628
• Main Authors: Hu, Jian, Jin, Dachun, Fan, Runze, Xie, Xiaodu, Zhou, Zhihao, Chen, Yanlin, Zhang, Yao, Zhang, Jun, Gao, Liang, Jiang, Jun, Zhang, Yuanfeng, Liang, Peihe
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.07.2022; Springer Nature B.V
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; ChiCTR; ChiCTR2000034080; Humans; Ischemia; Kidney Neoplasms - surgery; Kidneys; Laparoscopy; Medicine; Medicine & Public Health; Nephrectomy; Nephrectomy - adverse effects; Nephrectomy - methods; Nephrology; Nephrology - Original Paper; Patients; Renal function; Retrospective Studies; Risk Factors; Treatment Outcome; Urology; Partial nephrectomy; AKI severity; Long-term renal function; AKI duration; Acute kidney injury
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-021-03033-z

Purpose To evaluate the effect of acute kidney injury (AKI) duration and severity on long-term renal functional outcomes in patients undergoing partial nephrectomy (PN). Methods Altogether 292 consecutive patients undergoing laparoscopic PN from 2010 to 2018 were identified in two medical centers. In addition, the AKI duration {transient AK [≤ 3d] or persistent AKI [> 3d]} was combined with AKI severity (stages) to elucidate their relationships with long-term functional results. Kaplan–Meier (KM) analysis was also used to compare among patients with no AKI, transient AKI, and persistent AKI. Moreover, the Cox-proportional hazards regression model was utilized to assess the risk factors for renal function deterioration. Results Altogether 67 patients (22.9%) experienced postoperative AKI. 75% eGFR preserve rate during the follow-up was compared among patients with no AKI, transient AKI and persistent AKI using KM analysis and log-rank test, which revealed significant difference. After adjusting for age and warm ischemia time by multivariate model proportional hazards analysis, AKI duration and severity were identified as the risk factors (Stage 1-transient AKI vs. non-AKI: adjusted hazard ratio (HR) 4.361, 95% confidential interval (CI) [2.062–9.233], p  < 0.001; stage 1-persistent AKI vs. non-AKI: adjusted HR 6.706, 95% CI [2.405–18.699], p  < 0.001; stage 2/3-transient AKI vs. non-AKI: adjusted HR 8.949, 95% CI [1.571–50.963], p  = 0.014; stage 2/3-persistent AKI vs. non-AKI: adjusted HR 13.453, 95% CI [11.353–133.798], p  = 0.027). Conclusions The AKI duration after PN is an important risk factor for long-term renal functional deterioration. Besides, AKI duration combined with AKI severity can be more comprehensive to understand the role of AKI on ultimately renal function. Trial registration Chinese ClinicalTrials: ChiCTR2000034080.