Risk Factors Of Acute Kidney Injury After Esophageal Cancer Resection

Objective: To investigate the incidence and risk factors of acute kidney injury after esophageal cancer resection.Methods:The data of patients who were diagnosed as esophageal malignant tumor and received esophagectomy in the Fourth Hospital of Hebei Medical University from January 2013 to January 2019 were collected,including:basic information of patients: age,gender,body mass index(BMI),postoperative pathological type,smoking history,preoperative chemotherapy history,hypertension,diabetes mellitus,coronary heart disease;preoperative laboratory examination results(classified according to the standard of laboratory instruments and clinical diagnostic criteria): preoperative blood routine,electrolytes,preoperative liver and kidney function,blood glucose;intraoperative information: anesthesia strategy,anesthesia time,operation time,number of incisions,intraoperative blood transfusion,intraoperative total fluid infusion,amount of crystal and colloid.The main outcome was the occurrence of postoperative acute kidney injury(AKI).The postoperative AKI was the case group(group A),and the same number of data were randomly selected from the cases that never had AKI at a 1:1 ratio based on age and gender to form the control group(group C).Univariate and multivariate logistic regression were used to determine the risk factors of AKI after esophagectomy.Results:1.A total of 3431 cases were finally included in the study,including 166 cases in the AKI group.The incidence of AKI after esophageal cancer was 4.8%.2.Univariate logistic analysis showed that there were no significant differences between the two groups in BMI,pathological type of esophageal cancer,smoking history,diabetes mellitus,coronary heart disease,preoperative chemotherapy,preoperative platelet count,serum potassium,chlorine,urea nitrogen(BUN),anesthesia strategy,intraoperative fluid infusion volume and number of surgical incision(P > 0.05).There was a significantly higher prevalence of hypertension in the AKI group.There were more patients in group A which have higher WBC,ALT,AST,Cr,blood glucose and lower hemoglobin(Hb),Na,Ca,albumin than in group C.While the patients in group A may experience longer operation time and anesthesia time(P < 0.05).More patients in group A had received blood transfusion during operation(P < 0.05).3.Multivariate logistic regression showed that the independent risk factors of AKI after esophageal cancer resection included:hypertension(OR 1.886;95% CI 1.114-3.195),hypocalcemia(OR 8.221;95%CI 2.715～24.893),hypoalbuminemia(OR 2.952;95% CI 1.726～5.047),longer operation time(OR 1.005;95% CI 1.001～1.008).Conclusions:The incidence of AKI after esophageal cancer resection was 4.8%.Hypertension,hypocalcemia,hypoalbuminemia and prolonged operation time were independent risk factors for AKI.