title: Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma.
abstract: To investigate the prevalence, temporal trends, and predictors of postoperative acute kidney injury (AKI) in a large cohort of patients with renal cell carcinoma treated with radical or partial nephrectomy.
  
  
  
  Between January 1998 and December 2010, patients who underwent radical or partial tumor nephrectomy were identified within the Nationwide Inpatient Sample. First, prevalence and temporal trends of AKI were analyzed. Second, predictors of AKI were identified using multivariable regression analyses. Third, associations between AKI and in-hospital complications, length of stay, hospital costs, and in-hospital mortality were evaluated using logistic regression models adjusted for clustering.
  
  
  
  Of total 253,046 patients, 5.5% (14,303 in radical and 3,525 in partial nephrectomy) experienced AKI. Rates of AKI significantly increased from 2.0% in 1998 to 10.4% in 2010 (P<0.001). Predictors of AKI included male sex, radical nephrectomy, more contemporary years (2004-2010), older age, black race, higher comorbidities, higher preoperative chronic kidney disease stage, Medicare insurance status, and nephrectomy at urban hospitals (all P<0.01). Postoperative AKI during hospitalization was associated with an increased rate of in-hospital mortality, any complications, transfusion, prolonged length of stay, and higher hospital costs (all P<0.001).
  
  
  
  Rising rates of in-hospital AKI after radical and partial nephrectomy were observed. Increasing awareness of AKI, identification of patients at risk before surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, long-term renal functional follow-up, and a well-designed prospective study, may be warranted.
authors.affiliation: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA; 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: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Krishna
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.affiliation: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.affiliation: Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
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: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Division of Urologic Surgery, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies
keywords: Acute kidney injury; Nationwide inpatient sample; Partial nephrectomy; Radical nephrectomy; Renal cell carcinoma; Trends