Analysis Of Risk Factors For Acute Kidney Injury After Radical Esophagectomy

ObjectivesTo evaluate the incidence and perioperative risk factors of acute renal injury(Acute Kidney Injury,AKI)after radical resection of esophageal cancer,and to explore the best perioperative fluid management.MethodsA single center retrospective analysis was used to include 553 adult patients who underwent elective radical resection of esophageal cancer in hospital from June 2017 to October 2019.The diagnostic criteria of postoperative acute renal injury were KDIGO criteria.According to the statistical method,the intraoperative and postoperative infusion volume was divided into three groups: the first group was≤5.5 ml/(kg·h),the second group was 5.5-7.0 ml/(kg·h),and the third group was>7.0 ml/(kg·h).On the day of operation(Post-operative day 0,POD 0),the infusion volume in the ward was divided into three groups: ≤2.5L,2.5-4.0 L and>4.0L.The total infusion volume of POD 0 was divided into three groups according to the distance of 2.1 L,group 1 was ≤ 3.9L,group 2 was 3.9L-6.0L,group 3 was>6.0 L.In this study,univariate analysis and binary Logistic multivariate regression analysis were used to determine the perioperative factors related to the occurrence of postoperative AKI.ResultsAccording to the exclusion criteria and inclusion criteria,the final study subjects were 546 cases,of which 32 cases developed AKI after operation,with an incidence of about 5.86%(according to AKIN diagnostic criteria,28 cases had an incidence of 5.13%).The results of univariate analysis were as follows:hypertension history of postoperative AKI and non-AKI,postoperative hypoproteinemia,transfusion volume during anesthesia,ward transfusion volume,total transfusion volume of operation day and postoperative hospital stay,the difference between the two groups was statistically significant.Multivariate Logistic regression analysis showed that after taking into account factors such as age,sex,hypertension,diabetes,BMI,intraoperative and postoperative infusion volume,intraoperative blood pressure,preoperative radiotherapy and chemotherapy,history of tobacco and alcohol,etc.,the results were as follows:(1)Hypertension was an independent risk factor for postoperative AKI.(2)the duration of anesthesia is an independent risk factor for the occurrence of AKI after operation,and the risk of postoperative AKI increases 1.4 times for each hour of increase(OR is 1.441,95% CI is 1.081-1.922).(3)There was a "U" relationship between intraoperative infusion volume and postoperative AKI,that is,the incidence of postoperative AKI was the lowest when intraoperative infusion volume was between 5.5-7.0 ml/(kg·h).When intraoperative infusion volume was>7.0ml/(kg·h)and≤5.5ml/(kg·h),the postoperative AKI risk was 1.50 times(OR=1.503,95%CI is1.107-2.040)or 3.26 times higher than that of 5.5-7.0ml/(kg·h)patients(OR=3.259,95%CI is1.027-10.345).(4)The POD 0 infusion volume in ward is an independent risk factor for postoperative AKI.With each 1.5 L increase in ward infusion volume,the risk of postoperative AKI increases 3.31 times(OR=3.311,95%CI is 1.430-7.665);(5)the total POD 0 infusion volume is an independent risk factor for postoperative AKI.For each increase of 2.1L,the postoperative AKI risk increases 2.86 times(OR=2.857,95%CI is 1.375-5.938).ConclusionThis study found that history of hypertension,prolonged anesthesia,intraoperative infusion volume,postoperative ward infusion volume,and total POD 0infusion volume were independent risk factors for postoperative AKI.The amount of intraoperative fluid transfusion and the occurrence of postoperative AKI showed a "U" relationship.When the amount of intraoperative fluid was between 5.5-7.0ml/(kg·h),the incidence of postoperative AKI was the lowest.In addition,keeping the infusion volume of the ward<4.0L and the total infusion volume of the operation day<6.0L can minimize the risk of postoperative AKI.