The impact of comorbidities, sex and age on the occurrence of acute kidney injury among patients undergoing nephron-sparing surgery.

ABSTRACT

BACKGROUND: The aim of this study was to report the impact of patients' baseline characteristics on the incidence of acute kidney injury (AKI) after nephron-sparing surgery (NSS) for localized kidney cancer. PATIENTS AND METHODS: Data from our kidney cancer database were retrospectively extracted to include 402 patients who underwent NSS between March 2000 and June 2016, and had sufficient data. Definition of AKI was based on the postoperative serum creatinine levels and estimated glomerular filtration rate (eGFR) magnitude, which were measured during the 72 h after surgery. RESULTS: Based on RIFLE and AKIN criteria, the overall rate of postoperative AKI was 35%. The average decrease in eGFR among patients who developed AKI was 20% as compared with the non-AKI subgroup (2%). In univariate analysis, variables that were associated with AKI included right-sided tumors (p = 0.014), male sex (p = 0.01), hypertension (p = 0.003), baseline eGFR (p = 0.009) and history of nephrolithiasis (p = 0.039). However, multivariate analysis revealed that the only independent predictors of postoperative AKI were hypertension (p = 0.009) and cigarette smoking (p = 0.024). CONCLUSION: AKI is a common complication of NSS affecting about one-third of the patients. The most important risk factors are hypertension and smoking.