scholarly journals Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

2019 ◽  
Vol 8 (4) ◽  
pp. 468 ◽  
Author(s):  
Na Young Kim ◽  
Jung Hwa Hong ◽  
Dong Hoon Koh ◽  
Jongsoo Lee ◽  
Hoon Jae Nam ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Partial Nephrectomy ◽  
Kidney Injury ◽  
Invasive Technique ◽  
Male Sex ◽  
Postoperative Aki

Postoperative acute kidney injury (AKI) is still a concern in partial nephrectomy (PN), even with the development of minimally invasive technique. We aimed to compare AKI incidence between patients with and without diabetes mellitus (DM) and to determine the predictive factors for postoperative AKI. This case-matched retrospective study included 884 patients with preoperative creatinine levels ≤1.4 mg/dL who underwent laparoscopic or robot-assisted laparoscopic PN between December 2005 and May 2018. Propensity score matching was employed to match patients with and without DM in a 1:3 ratio (101 and 303 patients, respectively). Of 884 patients, 20.4% had postoperative AKI. After propensity score matching, the incidence of postoperative AKI in DM and non-DM patients was 30.7% and 14.9%, respectively (P < 0.001). In multivariate analysis, male sex and warm ischemia time (WIT) >25 min were significantly associated with postoperative AKI in patients with and without DM. In patients with DM, hemoglobin A1c (HbA1c) >7% was a predictive factor for AKI, odds ratio (OR) = 4.59 (95% CI, 1.47–14.36). In conclusion, DM increased the risk of AKI after minimally invasive PN; male sex, longer WIT, and elevated HbA1c were independent risk factors for AKI in patients with DM.

scholarly journals Emergency angiography for trauma patients and potential association with acute kidney injury

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ryo Yamamoto ◽  
Ramon F. Cestero ◽  
Jo Yoshizawa ◽  
Katsuya Maeshima ◽  
Junichi Sasaki
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Injury Severity ◽  
Vital Signs ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Potential Association ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Background Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

scholarly journals Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

2021 ◽  
Vol 10 (7) ◽  
pp. 1373
Author(s):  
Sunil Pillai ◽  
Akshay Kriplani ◽  
Arun Chawla ◽  
Bhaskar Somani ◽  
Akhilesh Pandey ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Percutaneous Nephrolithotomy ◽  
Ace Inhibitors ◽  
Operative Time ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Postoperative Aki

Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender, body mass index (BMI), comorbidities (hypertension, diabetes mellitus), and drug history—particularly angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers and beta blockers. Laboratory data included serial serum creatinine measured pre- and postoperation (12, 24, and 48 h), hemoglobin (Hb), total leucocyte count (TLC), Prothrombin time (PT), serum uric acid and urine culture. Stone factors were assessed by noncontrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden, location and Hounsfield values. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Postoperative complications were documented using the modified Clavien–Dindo grading system and patients with postoperative AKI were followed up with serial creatinine measurements up to 1 year. Among the 509 patients analyzed, 47 (9.23%) developed postoperative AKI. Older patients, with associated hypertension and diabetes mellitus, those receiving ACE inhibitors and with lower preoperative hemoglobin and higher serum uric acid, had higher incidence of AKI. Higher stone volume and density, staghorn stones, multiple punctures and longer operative time were significantly associated with postoperative AKI. Patients with AKI had an increased length of hospital stay and 17% patients progressed to chronic kidney disease (CKD). Cut-off values for patient age (39.5 years), serum uric acid (4.05 mg/dL) and stone volume (673.06 mm3) were assessed by receiver operating characteristic (ROC) curve analysis. Highlighting the strong predictors of post-PNL AKI allows early identification, proper counseling and postoperative planning and management in an attempt to avoid further insult to the kidney.

Perioperative Anaemia is a Risk Factor of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy

2020 ◽  
Author(s):  
Shun Zhang ◽  
Huangqi Duan ◽  
Yu Wu ◽  
Weimin Xia ◽  
Subo Qian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Risk Factor ◽  
Partial Nephrectomy ◽  
Pearson Correlation ◽  
Kidney Injury ◽  
Regression Analyses ◽  
Clinical Issue ◽  
The Impact ◽  
Postoperative Aki

Abstract Background Acute kidney injury (AKI) secondary to partial nephrectomy (PN) is a challenging clinical issue. During PN anaemia develops due to haemodilution and blood loss, which decreases oxygen transfer and provokes tissue hypoxia, leading to postoperative adverse outcomes. The aim of this study was to investigate the impact of perioperative anaemia on postoperative AKI after PN.Methods This retrospective cohort study included 68 adult patients undergoing PN for a single nonmetastatic renal tumor. Detailed clinical information was systematically reviewed and analyzed. Serum concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and creatinine (sCr) were tested before, 2 hours and 1 day after PN surgery. Perioperative anaemia was assessed according to haematocrit (Ht) value at the same timepoint. Association between perioperative anaemia and postoperative AKI were explored by logistic regression analyses and pearson correlation analysis. Results The rate of perioperative anaemia in patients undergoing PN was 35.3% when the criteria of Ht < 30% was adopted. AKI developed in 32.4% of the patients when KDIGO criteria was applicated and in 51.5% of the patients when the criteria of serum NGAL >150 ng/mL was used. The incidence of AKI in patients with perioperative anaemia was higher than that in patients without anaemia. Univariate logistic regression analyses showed perioperative anaemia was a relevant factor of postoperative AKI in patients undergoing PN.Conclusions Perioperative anaemia might be a risk factor of postoperative AKI after PN. But the detailed interrelation still needs to be verified by large-scale prospective studies.

scholarly journals Predictive role of vitamin B12 in acute kidney injury in living donor liver transplantation: a propensity score matching analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038990
Author(s):  
Jaesik Park ◽  
Jung Hee Choi ◽  
Ho Joong Choi ◽  
Sang Hyun Hong ◽  
Chul Soo Park ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Kidney Injury ◽  
Vitamin B ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Postoperative Aki

ObjectivesWe examine the association between vitamin B12 level and risk for acute kidney injury (AKI) in patients undergoing living donor liver transplantation (LDLT).DesignRetrospective observational cohort study.SettingUniversity hospital, from January 2009 to December 2018.ParticipantsA total of 591 patients who underwent elective LDLT were analysed in this study. Those with a preoperative history of kidney dysfunction, vitamin B12 supplementation due to alcoholism, low vitamin B12 (<200 pg/mL) or missing laboratory data were excluded.Primary and secondary outcome measuresThe population was classified into AKI and non-AKI groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, and associations between perioperative factors and AKI were analysed. After 1:1 propensity score (PS) matching, the association between high vitamin B12 (>900 pg/mL) and postoperative AKI was evaluated.ResultsPreoperative vitamin B12 was higher in the AKI group. Potentially significant perioperative factors from univariate analyses were entered into multivariate analyses, including preoperative factors (vitamin B12, diabetes), intraoperative factors (hourly urine output) and donor graft fatty change in LDLT patients. PS matching analyses with adjustment using PS revealed that high serum vitamin B12 (>900 pg/mL) was associated with risk for AKI, and the risk was 2.8-fold higher in patients with high vitamin B12 than in those with normal vitamin B12. Higher vitamin B12 was also related to a higher AKI stage. In addition, inflammatory factors (C reactive protein, white blood cells and albumin) were associated with vitamin B12 level.ConclusionsOur study may improve the accuracy of predicting postoperative AKI by introducing preoperative vitamin B12 into risk assessments for patients undergoing LDLT.

scholarly journals Comparison of the Effects of Laparoscopic and Open Surgery on Postoperative Acute Kidney Injury in Patients with Colorectal Cancer: Propensity Score Analysis

2021 ◽  
Vol 10 (7) ◽  
pp. 1438
Author(s):  
Ji Hoon Sim ◽  
Sa-Jin Kang ◽  
Ji-Yeon Bang ◽  
Jun-Gol Song
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Acute Kidney Injury ◽  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Hospital Stay ◽  
Open Surgery ◽  
Kidney Injury ◽  
Icu Admission ◽  
Postoperative Aki

Postoperative acute kidney injury (AKI) is a serious complication that increases patient morbidity and mortality. However, few studies have evaluated the effect of laparoscopic surgery on postoperative AKI. This study compared the incidence of postoperative AKI between laparoscopic and open surgery in patients with colorectal cancer. This study retrospectively analyzed 3637 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into laparoscopic (n = 987) and open (n = 2650) surgery groups. We performed multivariable regression analysis to assess the risk factors for AKI and propensity score matching analysis to compare the incidence of AKI between the two groups. We also assessed postoperative intensive care unit (ICU) admission, complications, hospital stay, and 1-year mortality. We observed no significant differences in the incidence of postoperative AKI between the two groups before (8.8% vs. 9.1%, p = 0.406) and after (8.8% vs. 7.7%, p = 0.406) matching. Laparoscopic surgery was not associated with AKI even after adjusting for intraoperative variables (adjusted odds ratio (OR): 1.17, 95% confidence interval (CI): 0.84–1.62, p = 0.355). Body mass index, diabetes mellitus, hypertension, and albumin were risk factors for AKI. ICU admission (0.6% vs. 2.5%, p = 0.001), complications (0.2% vs. 1.5%, p = 0.002), hospital stay (6.89 days vs. 8.61 days, p < 0.001), and 1-year mortality (0.1% vs. 0.9%, p = 0.021) were significantly better in the laparoscopic than in the open group. The incidence of postoperative AKI did not differ significantly between laparoscopic and open surgery. However, considering its better surgical outcomes, laparoscopic surgery may be recommended for patients with colorectal cancer.

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