Impact of Transient and Persistent Acute Kidney Injury on Chronic Kidney Disease Progression and Mortality after Gastric Surgery for Gastric Cancer

Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Sun-Seog Kweon, Soo Wan Kim, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Sun-Seog Kweon, Soo Wan Kim

Abstract

Acute kidney injury (AKI) is common after gastric surgery for gastric cancer and associated with adverse outcomes. However, the impact of transient or persistent AKI on clinical outcomes after gastric surgery for gastric cancer has not been described. We performed a retrospective study of 4,886 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2012. AKI patients were classified as transient and persistent AKI based on the return of serum creatinine to the level indicating no AKI within 7 days. Our outcomes included occurrence of new-onset chronic kidney disease (CKD) and mortality 1 year after gastric surgery. AKI occurred in 638 (13.1%) after gastric surgery. Transient AKI was documented in 574 (90%). Use of diuretics and contrast agents was a common risk factor for persistent and transient AKI. Length of intensive care unit (ICU) and hospital stay, and ICU admission rate were higher in patients with transient AKI than in those without AKI. Although patients with persistent AKI had a higher new-onset CKD 1 year after gastric surgery after adjusting for multiple covariates, transient AKI was not associated with new-onset CKD. The 1-year mortality rates were significantly higher in patients with transient and persistent AKI. Not only persistent AKI but transient AKI is associated with increased risk of hospital complications and a significantly higher risk of long-term mortality than patients without AKI after gastric surgery. Moreover, persistent AKI, but not transient AKI, is associated with CKD progression at 1 year.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Kaplan–Meier survival curves in patients…
Fig 1. Kaplan–Meier survival curves in patients after gastric surgery for gastric cancer with transient AKI, persistent AKI, and no AKI.

References

    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8. 10.1001/jama.294.7.813
    1. Bihorac A, Brennan M, Ozrazgat-Baslanti T, Bozorgmehri S, Efron PA, Moore FA, et al. National surgical quality improvement program underestimates the risk associated with mild and moderate postoperative acute kidney injury. Crit Care Med. 2013;41:2570–83. 10.1097/CCM.0b013e31829860fc
    1. Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol. 2005;16:195–200. 10.1681/ASN.2003100875
    1. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;302:1179–85. 10.1001/jama.2009.1322
    1. Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009;249:851–8. 10.1097/SLA.0b013e3181a40a0b
    1. Kim CS, Oak CY, Kim HY, Kang YU, Choi JS, Bae EH, et al. Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer. PLoS One. 2013;8:e82289 10.1371/journal.pone.0082289
    1. Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant. 2010;25:1833–9. 10.1093/ndt/gfp624
    1. Fidalgo P, Ahmed M, Meyer SR, Lien D, Weinkauf J, Kapasi A, et al. Association between transient acute kidney injury and morbidity and mortality after lung transplantation: a retrospective cohort study. J Crit Care. 2014;29:1028–34. 10.1016/j.jcrc.2014.07.024
    1. Choi JS, Kim YA, Kim MJ, Kang YU, Kim CS, Bae EH, et al. Relation between transient or persistent acute kidney injury and long-term mortality in patients with myocardial infarction. Am J Cardiol. 2013;112:41–5. 10.1016/j.amjcard.2013.02.051
    1. Wi J, Ko YG, Kim JS, Kim BK, Choi D, Ha JW, et al. Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart. 2011;97:1753–7. 10.1136/hrt.2010.218677
    1. Mosier MJ, Pham TN, Klein MB, Gibran NS, Arnoldo BD, Gamelli RL, et al. Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. J Burn Care Res. 2010;31:83–92. 10.1097/BCR.0b013e3181cb8c87
    1. Wehbe E, Duncan AE, Dar G, Budev M, Stephany B. Recovery from AKI and short- and long-term outcomes after lung transplantation. Clin J Am Soc Nephrol. 2013;8:19–25. 10.2215/CJN.04800512
    1. Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17:204 10.1186/cc11454
    1. Section 2: AKI Definition. Kidney Int Suppl (2011). 2012;2:19–36.
    1. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.
    1. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4. 10.1245/s10434-010-0985-4
    1. Lee EH, Baek SH, Chin JH, Choi DK, Son HJ, Kim WJ, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med. 2012;38:1478–86. 10.1007/s00134-012-2599-8
    1. Field A. Discovering Statistics Using SPSS. Third ed. London: Sage; 2009. 372–3 p.
    1. Bucaloiu ID, Kirchner HL, Norfolk ER, Hartle JE 2nd, Perkins RM. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012;81:477–85. 10.1038/ki.2011.405
    1. Jones J, Holmen J, De Graauw J, Jovanovich A, Thornton S, Chonchol M. Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality. Am J Kidney Dis. 2012;60:402–8. 10.1053/j.ajkd.2012.03.014
    1. Heung M, Steffick DE, Zivin K, Gillespie BW, Banerjee T, Hsu CY, et al. Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data. Am J Kidney Dis. 2015.
    1. Zager RA, Johnson AC, Becker K. Acute unilateral ischemic renal injury induces progressive renal inflammation, lipid accumulation, histone modification, and "end-stage" kidney disease. Am J Physiol Renal Physiol. 2011;301:F1334–45. 10.1152/ajprenal.00431.2011
    1. Spurgeon-Pechman KR, Donohoe DL, Mattson DL, Lund H, James L, Basile DP. Recovery from acute renal failure predisposes hypertension and secondary renal disease in response to elevated sodium. Am J Physiol Renal Physiol. 2007;293:F269–78. 10.1152/ajprenal.00279.2006
    1. Heung M, Chawla LS. Predicting progression to chronic kidney disease after recovery from acute kidney injury. Curr Opin Nephrol Hypertens. 2012;21:628–34. 10.1097/MNH.0b013e3283588f24
    1. Chalikias G, Drosos I, Tziakas DN. Contrast-Induced Acute Kidney Injury: An Update. Cardiovasc Drugs Ther. 2016;30:215–28. 10.1007/s10557-015-6635-0

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi