Residual urine output and postoperative mortality in maintenance hemodialysis patients.
BACKGROUND
The relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown.


OBJECTIVE
To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients.


METHODS
A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dialysis. Propensity scores for postoperative anuria were developed.


RESULTS
Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to nonanuria (P = .03) and 5.13 for preoperative anuria vs nonanuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045).


CONCLUSIONS
Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity.
Lin
Yu-Feng
YF
Division of Nephrology, National Taiwan University Hospital, Yun-Lin, Taiwan.
Wu
Vin-Cent
VC
Ko
Wen-Je
WJ
Chen
Yih-Sharng
YS
Chen
Yung-Ming
YM
Li
Wen-Yi
WY
Chou
Nai-Kuan
NK
Chao
Anne
A
Huang
Tao-Min
TM
Chang
Fan-Chi
FC
Chen
Shih-I
SI
Shiao
Chih-Chung
CC
Wang
Wei-Jie
WJ
Tsai
Hung-Bin
HB
Tsai
Pi-Ru
PR
Hu
Fu-Chang
FC
Wu
Kwan-Dun
KD
D000368:Aged; D001002:Anuria / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D016896:Treatment Outcome