title: Epidural analgesia and perioperative kidney function after major liver resection.
abstract: BACKGROUND
  Epidural analgesia (EDA) is a common analgesia regimen in liver resection, and is accompanied by sympathicolysis, peripheral vasodilatation and hypotension in the context of deliberate intraoperative low central venous pressure. This associated fall in mean arterial pressure may compromise renal blood pressure autoregulation and lead to acute kidney injury (AKI). This study investigated whether EDA is a risk factor for postoperative AKI after liver surgery.
  
  
  METHODS
  The incidence of AKI was investigated retrospectively in patients who underwent liver resection with or without EDA between 2002 and 2012. Univariable and multivariable analyses were performed including recognized preoperative and intraoperative predictors of posthepatectomy renal failure.
  
  
  RESULTS
  A series of 1153 patients was investigated. AKI occurred in 8·2 per cent of patients and was associated with increased morbidity (71 versus 47·3 per cent; P = 0·003) and mortality (21 versus 0·3 per cent; P <  0·001) rates. The incidence of AKI was significantly higher in the EDA group (10·1 versus 3·7 per cent; P = 0·003). Although there was no significant difference in the incidence of AKI between patients undergoing minor hepatectomy with or without EDA (5·2 versus 2·7 per cent; P = 0·421), a substantial difference in AKI rates occurred in patients undergoing major hepatectomy (13·8 versus 5·0 per cent; P = 0·025). In multivariable analysis, EDA remained an independent risk factor for AKI after hepatectomy (P = 0·040).
  
  
  CONCLUSIONS
  EDA may be a risk factor for postoperative AKI after major hepatectomy.
authors: Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, Zurich, Switzerland.
authors: P
authors: P
authors: Kambakamba
authors: K
authors: K
authors: Slankamenac
authors: C
authors: C
authors: Tschuor
authors: P
authors: P
authors: Kron
authors: A
authors: A
authors: Wirsching
authors: K
authors: K
authors: Maurer
authors: H
authors: H
authors: Petrowsky
authors: P A
authors: PA
authors: Clavien
authors: M
authors: M
authors: Lesurtel
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015360:Analgesia, Epidural / Q000009:adverse effects*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006498:Hepatectomy / Q000009:adverse effects*; D015994:Incidence; D007677:Kidney Function Tests; D008113:Liver Neoplasms / Q000601:surgery; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology