title: Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer.
abstract: BACKGROUND
  Postoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes.
  
  
  METHODS
  We conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline.
  
  
  RESULTS
  Of the 4718 patients, 679 (14.4%) developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2%) were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl); use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments.
  
  
  CONCLUSIONS
  AKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chang Seong
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chan Young
authors.initials: CY
authors.lastname: Oak
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ha Yeon
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Yong Un
authors.initials: YU
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Eun Hui
authors.initials: EH
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seong Kwon
authors.initials: SK
authors.lastname: Ma
authors.affiliation: Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea ; Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun-gun, Republic of Korea.
authors.forename: Sun-Seog
authors.initials: SS
authors.lastname: Kweon
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome