Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer

Chang Seong Kim, Chan Young Oak, Ha Yeon Kim, Yong Un Kang, Joon Seok Choi, Eun Hui Bae, Seong Kwon Ma, Sun-Seog Kweon, Soo Wan Kim, Chang Seong Kim, Chan Young Oak, Ha Yeon Kim, Yong Un Kang, Joon Seok Choi, Eun Hui Bae, Seong Kwon Ma, Sun-Seog Kweon, Soo Wan Kim

Abstract

Background: Postoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes.

Methods: We conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline.

Results: Of the 4718 patients, 679 (14.4%) developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2%) were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl); use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments.

Conclusions: AKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Acute kidney injury (AKI) stages…
Figure 1. Acute kidney injury (AKI) stages in gastric cancer patients who underwent gastric surgery.
Figure 2. In-hospital and 3-month mortality according…
Figure 2. In-hospital and 3-month mortality according to the AKI stages.

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