Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Urology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
Investig Clin Urol. 2022 Sep;63(5):514-522. doi: 10.4111/icu.20220160.
Partial nephrectomy (PN) induced kidney injury is still a challenging clinical matter that has not been completely conquered. This study aimed to explore the influences of perioperative anemia on renal function after PN.
A total of 114 patients undergoing PN were retrospectively studied. Serum creatinine was tested preoperatively and 24 hours and 3 days after PN to evaluate the occurrence of acute kidney injury (AKI). Perioperative anemia was evaluated on the basis of the hemoglobin (Hb) value at 24 hours and 3 days postoperation. Patients were then followed up for the development of chronic kidney disease (CKD). Associations between perioperative anemia and postoperative AKI and CKD were determined.
The cumulative incidence of perioperative anemia was 33.33% in the study. A total of 32.46% of patients suffered from postoperative AKI, and 16.67% of patients progressed to CKD. The incidences of AKI and CKD in perioperative anemia patients were dramatically exceeded in those without anemia. Further statistical analyses indicated that perioperative anemia was a relevant factor for postoperative kidney injury, presenting the highest odds ratio of 31.272 for postoperative AKI and 17.179 for postoperative CKD. Receiver operating characteristic curve analysis showed that ΔHb=(preoperative Hb)-(postoperative Hb nadir) was a meaningful predictor of postoperative kidney injury, with an area under the curve of 0.784 for predicting postoperative AKI and 0.805 for postoperative CKD.
Perioperative anemia can predict kidney injury after PN, and ΔHb shows a meaningful predictive value for postoperative AKI and CKD.
部分肾切除术（PN）引起的肾损伤仍然是一个具有挑战性的临床问题，尚未完全解决。本研究旨在探讨围手术期贫血对 PN 后肾功能的影响。
回顾性研究了 114 例行 PN 的患者。术前和 PN 后 24 小时和 3 天检测血清肌酐，以评估急性肾损伤（AKI）的发生。根据术后 24 小时和 3 天的血红蛋白（Hb）值评估围手术期贫血。然后对患者进行慢性肾脏病（CKD）的发展进行随访。确定围手术期贫血与术后 AKI 和 CKD 之间的关系。
研究中围手术期贫血的累积发生率为 33.33%。共有 32.46%的患者发生术后 AKI，16.67%的患者进展为 CKD。贫血患者的 AKI 和 CKD 发生率明显高于非贫血患者。进一步的统计分析表明，围手术期贫血是术后肾损伤的相关因素，其术后 AKI 的优势比最高，为 31.272，术后 CKD 的优势比为 17.179。受试者工作特征曲线分析表明，ΔHb=（术前 Hb）-（术后 Hb 最低点）是术后肾损伤的有意义预测因子，其预测术后 AKI 的曲线下面积为 0.784，预测术后 CKD 的曲线下面积为 0.805。
围手术期贫血可预测 PN 后肾损伤，ΔHb 对术后 AKI 和 CKD 具有有意义的预测价值。
