Retrospective Evaluation of the Predictive Factors of Acute Kidney Injury after Liver Resection - Abstract
Introduction: The incidence and risk factors of Postoperative Acute Kidney Injury (PO-AKI) after liver surgery are not well established. The purpose of the present study was to evaluate the incidence and perioperative risk factors of PO-AKI in patients undergoing liver resection.
Methods: We conducted a retrospective study on consecutive patients undergoing any type of liver resection between November 1, 2008 and May 31, 2012 at Nippon Medical School Hospital. Electronic medical records were abstracted for comorbid conditions and intraoperative predictors with the potential for association with PO-AKI. The development of AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria definition.
Results: The study included 199 of 204 patients who underwent liver resection during the study period. The other five cases were excluded because they underwent renal replacement therapy before surgery. The AKI rate was 23.6% (47 of 199 patients), four of whom (8.5% of AKI patients) required renal replacement therapy.
Multivariate analysis identified BMI (odds ratio: 1.20, 95% CI: 1.07-1.36, P=0.003), CKD (odds ratio: 3.31, 95% CI: 1.32-8.46, P=0.011), platelet count (odds ratio: 0.94, 95% CI: 0.89-0.99, P=0.022) and albumin (odds ratio: 0.32, 95% CI: 0.14-0.70, P=0.004) as independent predictors of PO-AKI, but not intraoperative data such as
water balance and urine output.
Conclusion: This study suggests the importance of assessing patient characteristics preoperatively. Appreciation of risk factors for PO-AKI may help identify high-risk surgical populations.