title: Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma.
abstract: BACKGROUND
  Patients with renal cell carcinoma who were treated with radical nephrectomy (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI), and in consequence, short- and long-term adverse outcomes. We sought to identify independent predictors of 30-day AKI in patients undergoing RN or PN.
  
  
  METHODS
  Between 2005 and 2011, patients who underwent RN or PN for renal cell carcinoma within the National Surgical Quality Improvement Program data set were identified. Patients with preexisting severe renal failure, defined as a preoperative estimated glomerular filtration rate<30 ml/min/1.73 m(2), were excluded from the analyses. AKI was defined as an elevation of serum creatinine>2mg/dl above baseline or the need for dialysis within 30 days of surgery. Univariable and multivariable logistic regression analyses were used to examine the association between preoperative factors and the risk of postoperative AKI.
  
  
  RESULTS
  Overall, 1,944 (58.6%) and 1,376 (41.4%) patients underwent RN and PN, respectively. Overall, 1.8% of the patients included in the study experienced AKI within an average of 5.4 days after RN or PN. Independent predictors for AKI included obesity (odds ratio [OR] = 2.24, P = 0.04), history of neurovascular disease (OR = 5.29, P<0.001), and a preoperative chronic kidney disease stage II (OR = 10.00, P = 0.03) or stage III (OR = 26.49, P = 0.02). Furthermore, RN (OR = 2.87, P = 0.02) or the open approach (OR = 2.18, P = 0.04) was significantly associated with postoperative AKI. AKI was significantly associated with adverse postoperative outcomes, such as prolonged length of stay, occurrence of any complication, and mortality (all P <0.001).
  
  
  CONCLUSIONS
  The assessment of preoperative kidney function and comorbidity status is essential to identify patients at risk of postoperative AKI. In addition to preoperative chronic kidney disease stages II and III, neurovascular disease, obesity, and surgical approach (RN or open) represent predictors of 30-day AKI. Careful patient selection as well as preoperative planning may help reduce this unfavorable postoperative outcome.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: dr.marianne.schmid@gmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Abd-El-Rahman
authors.initials: AE
authors.lastname: Abd-El-Barr
authors.affiliation: Department of Urology, University Cita-Salute San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kola
authors.initials: K
authors.lastname: Olugbade
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Nedim
authors.initials: N
authors.lastname: Ruhotina
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Briony
authors.initials: B
authors.lastname: Varda
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute kidney injury; Outcomes; Predictors; Radical and partial nephrectomy; Renal cell carcinoma