Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Won Ho Kim, Kyung Won Shin, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Chang Wook Jeong, Cheol Kwak, Young-Jin Lim, Won Ho Kim, Kyung Won Shin, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Chang Wook Jeong, Cheol Kwak, Young-Jin Lim

Abstract

The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24-36 months after surgery) to the new baseline during 3-12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25-2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78-4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = -0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

Keywords: acute kidney injury; chronic kidney disease; functional change ratio; radical nephrectomy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Serial change in mean estimated glomerular filtration rate before surgery to three years after surgery according to the stages of acute kidney injury. * Significant difference between groups.
Figure 2
Figure 2
Comparison of the cumulative incidence of chronic kidney disease (estimated glomerular filtration rate (eGFR) 2) at follow-up time points between the patients without acute kidney injury (AKI), those with stage 1 AKI, and those with stage 2 or 3 AKI. There were significant differences in the incidence of chronic kidney disease at all time-points.
Figure 3
Figure 3
Kaplan–Meier survival curve analysis for new-onset chronic kidney disease stage 3a or higher (estimated glomerular filtration rate 2) or all-cause mortality as the primary outcome between different AKI groups. There were significant differences between the no AKI and AKI stage 1 groups (log-rank test p < 0.001) and between AKI stage 1 and stage 2 or 3 (log-rank test p = 0.023). The numbers of patients who had follow-up eGFR values at each time point were shown at the bottom of the figure.
Figure 4
Figure 4
Distribution of the long-term functional change ratio across the different creatinine ratios which were used to determine acute kidney injury stages. There was a significant correlation between the functional change ratio and creatinine change ratio from baseline (p < 0.001).
Figure 5
Figure 5
Comparison of the distribution of the Kidney Disease: Improving Global Outcomes chronic kidney disease (KDIGO CKD) stages during the follow-up period of 36 months between the patients with and without AKI after radical nephrectomy.

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