Acute kidney injury following gastrectomy may increase mortality, CKD incidence


Either transient or persistent acute kidney injury, commonly sustained after gastrectomy for gastric cancer, are associated with increased risk of hospital complications and mortality, a new study reports.

However, only persistent acute kidney injuries, and not transient ones, are related to the progression of chronic kidney diseases a year after surgery.

For the study, medical and laboratory records of adult patients who were subjected to partial or total gastrectomy to treat their gastric cancer between June 2002 and December 2012 were recovered and analysed.

Patients who had a postoperative glomerular filtration rate of <60 mL per minute per 1.73 m2; a history of kidney transplant, peritoneal dialysis or hemodialysis; emergency operations; chronic kidney diseases; and insufficient data in the records were excluded from the analysis. A total of 4,886 records of patients were then used for the retrospective analysis.

Other information recovered from the medical records included sex, heart rate, age, BMI, history of diabetes mellitus, smoking status, history of chronic obstructive pulmonary disease, TNM staging of gastric cancer, history of hypertension, and serum levels of serum creatinine, haemoglobin and albumin.

For the purposes of the study, acute kidney injury was defined following the standards of the Kidney Disease Improving Global Outcomes. Creatinine levels within 7 days post-operation were used as the basis of classifying acute kidney injury into transient or persistent. Moreover, those with a decrease in the estimated glomerular filtration rate to below 60 mL per minute per 1.73 m2 after gastrectomy were designated to have new-onset chronic kidney disease (CKD).

Of all patients assessed, acute kidney injury occurred in 13.1 percent or 638 patients after gastrectomy. Of these, 90 percent or 574 were found to have transient acute kidney injury. For both transient and persistent injuries, the use of antidiuretics was found to be a risk factor.

Compare with those without acute kidney injuries, the rates of admission into the ICU, the lengths of stay in the ICU, and the lengths of hospitalization were higher in the patients with acute kidney injuries.

After adjusting for covariates, patients with persistent acute kidney injury were found to have a higher risk of developing CKD a year after gastric surgery compared with those who had transient acute kidney injuries.

Finally, both persistent and transient acute kidney injuries experienced higher 1-year mortality rates.

The findings show that acute kidney injuries, both persistent and transient, negatively affect the outcomes of patients who have undergone gastric surgery for gastric cancer.