Robert J Ellis1,2,3, Sharon J Del Vecchio4,5,6, Benjamin Kalma4,5, Keng Lim Ng4,5,6, Christudas Morais4,5,6, Ross S Francis4,5,6, Glenda C Gobe4,5,6,7, Rebekah Ferris6, Simon T Wood4,5,6. 1. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia. r.ellis1@uq.edu.au. 2. Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia. r.ellis1@uq.edu.au. 3. Princess Alexandra Hospital, Brisbane, Australia. r.ellis1@uq.edu.au. 4. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia. 5. Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia. 6. Princess Alexandra Hospital, Brisbane, Australia. 7. NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.
Abstract
PURPOSE: The purpose of this study was to investigate whether preoperative dehydration and intraoperative hypotension were associated with postoperative acute kidney injury in patients managed surgically for kidney tumours. METHODS: A retrospective analysis of 184 patients who underwent nephrectomy at a single centre was performed, investigating associations between acute kidney injury after nephrectomy, and both intraoperative hypotension and preoperative hydration/volume status. Intraoperative hypotension was defined as mean arterial pressure < 60 mmHg for ≥ 5 min. Urine conductivity was evaluated as a surrogate measure of preoperative hydration (euhydrated < 15 mS/cm; mildly dehydrated 15-20 mS/cm; dehydrated > 20 mS/cm). Multivariable logistic regression was used to evaluate associations between exposures and the primary outcome, with adjustment made for potential confounders. RESULTS: Patients who were dehydrated and mildly dehydrated had an increased risk of acute kidney injury (adjusted odds ratio [aOR] 4.1, 95% CI 1.3-13.5; and aOR 2.4, 95% CI 1.1-5.3, respectively) compared with euhydrated patients (p = 0.009). Surgical approach appeared to modify this effect, where dehydrated patients undergoing laparoscopic surgery were most likely to develop acute kidney injury, compared with patients managed using an open approach. Intraoperative hypotension was not associated with acute kidney injury. CONCLUSION: Preoperative dehydration may be associated with postoperative acute kidney injury. Avoiding dehydration in the preoperative period may be advisable, and adherence to international evidence-based guidelines on preoperative fasting is recommended.
PURPOSE: The purpose of this study was to investigate whether preoperative dehydration and intraoperative hypotension were associated with postoperative acute kidney injury in patients managed surgically for kidney tumours. METHODS: A retrospective analysis of 184 patients who underwent nephrectomy at a single centre was performed, investigating associations between acute kidney injury after nephrectomy, and both intraoperative hypotension and preoperative hydration/volume status. Intraoperative hypotension was defined as mean arterial pressure < 60 mmHg for ≥ 5 min. Urine conductivity was evaluated as a surrogate measure of preoperative hydration (euhydrated < 15 mS/cm; mildly dehydrated 15-20 mS/cm; dehydrated > 20 mS/cm). Multivariable logistic regression was used to evaluate associations between exposures and the primary outcome, with adjustment made for potential confounders. RESULTS:Patients who were dehydrated and mildly dehydrated had an increased risk of acute kidney injury (adjusted odds ratio [aOR] 4.1, 95% CI 1.3-13.5; and aOR 2.4, 95% CI 1.1-5.3, respectively) compared with euhydrated patients (p = 0.009). Surgical approach appeared to modify this effect, where dehydrated patients undergoing laparoscopic surgery were most likely to develop acute kidney injury, compared with patients managed using an open approach. Intraoperative hypotension was not associated with acute kidney injury. CONCLUSION: Preoperative dehydration may be associated with postoperative acute kidney injury. Avoiding dehydration in the preoperative period may be advisable, and adherence to international evidence-based guidelines on preoperative fasting is recommended.
Authors: Zhobin Moghadamyeghaneh; Michael J Phelan; Joseph C Carmichael; Steven D Mills; Alessio Pigazzi; Ninh T Nguyen; Michael J Stamos Journal: J Gastrointest Surg Date: 2014-09-20 Impact factor: 3.452
Authors: Borje Ljungberg; Karim Bensalah; Steven Canfield; Saeed Dabestani; Fabian Hofmann; Milan Hora; Markus A Kuczyk; Thomas Lam; Lorenzo Marconi; Axel S Merseburger; Peter Mulders; Thomas Powles; Michael Staehler; Alessandro Volpe; Axel Bex Journal: Eur Urol Date: 2015-01-21 Impact factor: 20.096
Authors: Paul S Myles; Rinaldo Bellomo; Tomas Corcoran; Andrew Forbes; Philip Peyton; David Story; Chris Christophi; Kate Leslie; Shay McGuinness; Rachael Parke; Jonathan Serpell; Matthew T V Chan; Thomas Painter; Stuart McCluskey; Gary Minto; Sophie Wallace Journal: N Engl J Med Date: 2018-05-09 Impact factor: 91.245
Authors: Robert J Ellis; Sharon J Del Vecchio; Keng Lim Ng; Goce Dimeski; Elaine M Pascoe; Carmel M Hawley; David W Johnson; David A Vesey; Jeff S Coombes; Christudas Morais; Ross S Francis; Simon T Wood; Glenda C Gobe Journal: Transl Androl Urol Date: 2017-10
Authors: Konstantinos Kateros; Christos Doulgerakis; Spyridon P Galanakos; Vasileios I Sakellariou; Stamatios A Papadakis; George A Macheras Journal: BMC Nephrol Date: 2012-09-03 Impact factor: 2.388
Authors: M Wijnberge; J Schenk; E Bulle; A P Vlaar; K Maheshwari; M W Hollmann; J M Binnekade; B F Geerts; D P Veelo Journal: BJS Open Date: 2021-01-08
Authors: Roy Mano; Amy L Tin; Andrew W Silagy; Samuel C Haywood; Chun Huang; Nicole E Benfante; Gregory W Fischer; Andrew J Vickers; Paul Russo; Jonathan A Coleman; Patrick J McCormick; Joshua S Mincer; Abraham Ari Hakimi Journal: BJU Int Date: 2021-07-22 Impact factor: 5.969