title: Perioperative factors associated with acute kidney injury after partial nephrectomy.
abstract: BACKGROUND
  Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy.
  
  
  METHODS
  The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied.
  
  
  RESULTS
  A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min(-1) 1.73 m(-2) for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min(-1) 1.73 m(-2) lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min(-1) 1.73 m(-2) for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min(-1) 1.73 m(-2) for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min(-1) 1.73 m(-2) lower for patients who received warm ischemia as compared to cold ischemia.
  
  
  CONCLUSIONS
  Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Babazade
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Govindarajan
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Pal
authors.affiliation: Departments of Qualitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: You
authors.affiliation: Departments of Qualitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Mascha
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA Surgical ICU, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Khanna
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: F D
authors.initials: FD
authors.lastname: Marcano
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kaouk
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195, USA alparslanturan@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Turan
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D052096:Warm Ischemia / Q000706:statistics & numerical data
chemical_list: D003404:Creatinine
keywords: acute kidney injury; partial nephrectomy; perioperative factors