Prameela Konda1, Di Ai2, Carlos E Guerra3, Andrea Rodriguez-Restrepo1, Reza J Mehran4, David Rice4, Wayne Hofstetter4, Jagtar Heir1, Peter Kwater1, Vijaya Gottumukkala1, Mike Hernandez5, Juan P Cata6. 1. Departments of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX. 2. Department of Pathology, Baylor Scott and White Health, Temple, TX. 3. Department of Anesthesiology, Henry Ford Hospital, Wayne State University, Detroit, MI. 4. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX. 5. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX. 6. Anesthesiology and Surgical Oncology Research Group, Houston, TX. Electronic address: jcata@mdanderson.org.
Abstract
OBJECTIVE: To identify risks factors associated with acute kidney injury (AKI) after esophageal cancer surgery. DESIGN: This was a retrospective study. SETTING: Single academic center. PARTICIPANTS: Subjects with non-metastatic esophageal cancer. Patients were excluded if they were younger than 18 years and had missing data. MEASUREMENTS AND MAIN RESULTS: Primary outcome of the study was AKI according to AKI Network criteria. Demographic and perioperative variables were compared in patients with and without AKI. A multivariate Cox proportional model was used to assess the association between perioperative variables and AKI; p<0.05 was considered statistically significant. AKI was found in 107 (11.9%) of the 898 patients included in the study. The multivariate analysis also showed that BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), number of comorbidities (OR 1.52, 95% CI 1.20-1.93, p = 0.001), and preoperative creatinine concentrations (OR 2.37, 95% CI 1.14-4.92, p = 0.02) were independent predictors for AKI. The use of dexamethasone was associated with a reduced risk for AKI. CONCLUSIONS: In support of previous reports in the literature, the authors found that AKI was not an uncommon complication after esophageal surgery. Obesity, cardiovascular comorbidities, and high preoperative concentrations were predictors of AKI. Dexamethasone administration during surgery appeared to have a protective effect. This finding opens an opportunity to further study in a randomized controlled trial the efficacy of dexamethasone in the prevention of AKI.
OBJECTIVE: To identify risks factors associated with acute kidney injury (AKI) after esophageal cancer surgery. DESIGN: This was a retrospective study. SETTING: Single academic center. PARTICIPANTS: Subjects with non-metastatic esophageal cancer. Patients were excluded if they were younger than 18 years and had missing data. MEASUREMENTS AND MAIN RESULTS: Primary outcome of the study was AKI according to AKI Network criteria. Demographic and perioperative variables were compared in patients with and without AKI. A multivariate Cox proportional model was used to assess the association between perioperative variables and AKI; p<0.05 was considered statistically significant. AKI was found in 107 (11.9%) of the 898 patients included in the study. The multivariate analysis also showed that BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), number of comorbidities (OR 1.52, 95% CI 1.20-1.93, p = 0.001), and preoperative creatinine concentrations (OR 2.37, 95% CI 1.14-4.92, p = 0.02) were independent predictors for AKI. The use of dexamethasone was associated with a reduced risk for AKI. CONCLUSIONS: In support of previous reports in the literature, the authors found that AKI was not an uncommon complication after esophageal surgery. Obesity, cardiovascular comorbidities, and high preoperative concentrations were predictors of AKI. Dexamethasone administration during surgery appeared to have a protective effect. This finding opens an opportunity to further study in a randomized controlled trial the efficacy of dexamethasone in the prevention of AKI.
Authors: Andrew D Shaw; John A Kellum; John R Prowle; Lui G Forni; Max Bell; Michelle S Chew; Mark Edwards; Morgan E Grams; Michael P W Grocott; Kathleen D Liu; David McIlroy; Patrick T Murray; Marlies Ostermann; Alexander Zarbock; Sean M Bagshaw; Raquel Bartz; Samira Bell; Azra Bihorac; Tong J Gan; Charles E Hobson; Michael Joannidis; Jay L Koyner; Denny Z H Levett; Ravindra L Mehta; Timothy E Miller; Michael G Mythen; Mitra K Nadim; Rupert M Pearse; Thomas Rimmele; Claudio Ronco Journal: Nat Rev Nephrol Date: 2021-05-11 Impact factor: 28.314