Acute kidney injury after radical gastrectomy:incidence,risk factors,and impact on prognosis

Benlong Zhang; Li Li; Yunhe Gao; Zijian Wang; Yixun Lu; Lin Chen; Kecheng Zhang

doi:10.1093/gastro/goae061

摘要：Background:Acute kidney injury(AKI)is a serious adverse event often overlooked following major abdominal surgery.While radical gastrectomy stands as the primary curative method for treating gastric cancer patients,little information exists regarding AKI post-surgery.Hence,this study aimed to ascertain the incidence rate,risk factors,and consequences of AKI among patients undergoing radical gastrectomy. Methods:This was a population-based,retrospective cohort study.The incidence of AKI was calculated.Multivariate logistic regres-sion was used to identify independent predictors of AKI.Survival curves were plotted by using the Kaplan-Meier method and differ-ences in survival rates between groups were analyzed by using the log-rank test. Results:Of the 2,875 patients enrolled in this study,61(2.1%)developed postoperative AKI,with AKI Network 1,2,and 3 in 50(82.0%),6(9.8%),and 5(8.2%),respectively.Of these,49 patients had fully recovered by discharge.Risk factors for AKI after radical gastrec-tomy were preoperative hypertension(odds ratio[OR],1.877;95%CI,1.064-3.311;P¼0.030),intraoperative blood loss(OR,1.001;95%CI,1.000-1.002;P¼0.023),operation time(OR,1.303;95%CI,1.030-1.649;P¼0.027),and postoperative intensive care unit(ICU)admis-sion(OR,4.303;95%CI,2.301-8.045;P<0.001).The probability of postoperative complications,mortality during hospitalization,and length of stay in patients with AKI after surgery were significantly higher than those in patients without AKI.There was no statistical difference in overall survival(OS)rates between patients with AKI and without AKI(1-year,3-year,5-year overall survival rates of patients with AKI and without AKI were 93.3%vs 92.0%,70.9%vs 73.6%,and 57.1%vs 67.1%,respectively,P¼0.137). Conclusions:AKI following radical gastrectomy is relatively rare and typically self-limited.AKI is linked with preoperative hyperten-sion,intraoperative blood loss,operation time,and postoperative ICU admission.While AKI raises the likelihood of postoperative complications,it does not affect OS.