Analysis of risk factors for acute kidney injury after radical nephrectomy

Objective To explore the risk factors of acute kidney injury(AKI) in patients after radical nephrectomy. Methods We retrospectively collected clinical information of 920 patients with renal cell carcinoma who underwent radical nephrectomy at Zhongshan Hospital, Fudan University from February 2013 to September 2017. There were 612 male and 308 female patients included in this study, with a median age of 60 (range from 20-75 years). 313 patients (34.0%) had hypertension, 132 patients (14.3%) had diabetes, and 111 patients (12.1%) had smoking history. 829 cases (90.1%) were in stage 1-2 for preoperative renal function staging, and 91 cases (9.9%) were in stage 3-5. Preoperative hemoglobin was lower than the lower limit of normal in 391 cases (42.5%), white blood cell count increased in 66 cases (7.2%), and platelet increased in 72 cases (7.8%). Albumin was lower than the lower limit of normal in 65 cases (7.1%), lactate dehydrogenase increased in 73 cases (7.9%). blood urea nitrogen increased in 48 cases (5.2%), uric acid increased in 123 cases (13.4%), and urinary protein was positive in 88 cases (9.7%). 496 cases (53.9%) underwent open surgery and 424 (46.1%) underwent laparoscopic surgery. The changes in serum creatinine were followed up within 48 hours after surgery. AKI was defined according to the KDIGO standard. Logistic regression was used to analyze the risk factors for postoperative stage 2-3 AKI in patients. Results Stage 1-3 AKI occurred on 627, 42 and 10 patients during hospitalization, respectively. Univariate analysis showed that diabetes (OR=2.34, P=0.01), positive urine protein (OR=2.22, P=0.04), and elevated white blood cell count (OR=2.54, P=0.02) were significantly associated with postoperative stage 2-3 AKI. Multivariate logistic regression analysis showed that diabetes (OR=2.51, P=0.01) and elevated white blood cell count (OR=2.69, P=0.02) were independent risk factors for postoperative stage 2-3 AKI. Conclusion Renal cell carcinoma patients with diabetes or preoperative elevated white blood cell count are more likely to develop stage 2-3 AKI after radical nephrectomy. Key words: Carcinoma, renal cell; Nephrectomy; Acute kidney injury