Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Urol. 2019 Sep;76(3):398-403. doi: 10.1016/j.eururo.2019.04.040. Epub 2019 May 10.
The relationship between acute kidney injury (AKI) and long-term renal function is controversial. The influence of AKI duration on functional recovery after partial nephrectomy has never been investigated.
To investigate the association between AKI and renal function 1yr after partial nephrectomy, and whether this relationship is affected by the duration of AKI.
DESIGN, SETTING, AND PARTICIPANTS: We analyzed the data of 1893 patients treated by partial nephrectomy for a single cT1 N0 M0 renal mass.
We defined three outcomes of interest: (1) recovery of at least 90% of baseline function 1yr after partial nephrectomy, (2) percentage change of 1-yr renal function compared with baseline function, and (3) chronic kidney disease (CKD) upstaging. AKI was defined according to the RIFLE criteria and recorded up to the 7th postoperative day. The association between AKI and each endpoint of interest was examined using regression models after adjustment for common predictors of renal function.
A total of 388 (20%) patients experienced AKI after surgery. The rate of patients recovering 90% of baseline function was lower in the AKI group (30% vs 61%), while the proportion of patients who had CKD upstaging was significantly higher (51% vs 23%; both p<0.0001). At multivariable analysis, AKI was associated with worse renal function 1yr after partial nephrectomy, regardless of the outcome of interest (all p<0.0001). Longer AKI increases the risk of functional deterioration, especially after the 3rd day of injury. The risk of CKD upstaging for an average patient who had 1-3 versus ≥4 d of AKI was 46% (95% confidence interval [CI]: 40%, 52%) versus 67% (95% CI: 55%, 78%; absolute risk increase of 21%; 95% CI: 8%, 34%).
AKI negatively affects long-term functional recovery after partial nephrectomy, and thus, modifiable factors associated with AKI should be identified and corrected preoperatively. The duration of injury is informative, and should be included in the assessment of AKI and in future studies addressing this topic.
Proper functional recovery after partial nephrectomy is jeopardized by acute kidney injury (AKI). Inclusion of the dimension of time into classification systems for AKI may be beneficial for postoperative risk stratification.
急性肾损伤（AKI）与长期肾功能之间的关系存在争议。AKI 持续时间对部分肾切除术（partial nephrectomy）后功能恢复的影响从未被研究过。
探讨 AKI 与部分肾切除术后 1 年肾功能的关系，以及这种关系是否受 AKI 持续时间的影响。
设计、设置和参与者：我们分析了 1893 例因单个 cT1 N0 M0 肾肿瘤接受部分肾切除术治疗的患者数据。
我们定义了 3 个感兴趣的结果：（1）部分肾切除术后 1 年至少恢复基线功能的 90%；（2）1 年肾功能与基线功能的百分比变化；（3）慢性肾脏病（CKD）分期升级。根据 RIFLE 标准定义 AKI，并记录至术后第 7 天。使用回归模型，在调整肾功能常见预测因素后，评估 AKI 与每个感兴趣终点的关系。
共有 388（20%）例患者术后发生 AKI。AKI 组恢复基线功能 90%的患者比例较低（30%比 61%），而 CKD 分期升级的比例明显较高（51%比 23%；均 P<0.0001）。多变量分析显示，AKI 与部分肾切除术后 1 年肾功能较差相关，无论选择何种结果（均 P<0.0001）。AKI 持续时间延长会增加功能恶化的风险，尤其是在损伤后第 3 天。对于 AKI 持续时间为 1-3 天和≥4 天的平均患者，发生 CKD 分期升级的风险分别为 46%（95%CI：40%，52%）和 67%（95%CI：55%，78%）（绝对风险增加 21%；95%CI：8%，34%）。
AKI 会对部分肾切除术后的长期功能恢复产生负面影响，因此，应在术前识别和纠正与 AKI 相关的可改变因素。损伤持续时间具有提示性，应纳入 AKI 的评估和未来解决这一问题的研究中。
部分肾切除术后适当的功能恢复可能会因急性肾损伤（AKI）而受到影响。将时间维度纳入 AKI 分类系统可能有益于术后风险分层。
