Acute kidney injury following radical nephrectomy and inferior vena cava thrombectomy: A tertiary referral center experience.

PURPOSE: To investigate the incidence and determine the risk factors associated with acute kidney injury (AKI) following radical nephrectomy with inferior vena cava (IVC) thrombectomy. METHODS: We retrospectively reviewed the records of patients who underwent radical nephrectomy and IVC thrombectomy for renal cell carcinoma between 2000 and 2023. Patients on pre-existing renal replacement therapy were excluded. Postoperative AKI was diagnosed and classified into 3 stages according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression analysis was performed to evaluate the association between perioperative factors and the risk of developing moderate/severe AKI (KDIGO stage 2 or 3) following surgery. Renal function status at 90 days postoperatively was also evaluated in these patients. RESULTS: A total of 155 patients were included in the analysis. Median (IQR) age of the cohort was 65 (59-71) years, and 105 of the patients (68%) were male. Following surgery, 104 patients (67%) developed AKI, including 74 (48%) stage 1, 19 (12%) stage 2, and 11 (7%) stage 3. On multivariable logistic regression analysis, adjusting for age, coronary artery disease, and body mass index (BMI), obesity (BMI ≥ 30 kg/m2) was associated with a significantly higher rate of moderate or severe AKI following surgery (odds ratio 3.02, P = 0.02). Within the 90-day follow-up of patients with moderate/severe AKI, only 1 required dialysis. CONCLUSIONS: AKI is common after radical nephrectomy and IVC thrombectomy; however, most cases are mild and do not require dialysis. Obesity is associated with an increased risk of moderate to severe AKI following surgery.

Duke Scholars

Author Alireza Ghoreifi  

Author Michael R Abern Urology

Author Adam Richard Williams Surgery, Cardiovascular and Thoracic Surgery