The relationships of acute kidney injury duration and severity with long-term functional deterioration following partial nephrectomy.
The relationships of acute kidney injury duration and severity with long-term functional deterioration following partial nephrectomy.
复制标题
急性肾损伤持续时间和严重程度与肾部分切除术后长期功能恶化的关系。
DOI：
10.1007/s11255-021-03033-z
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发表时间：
2021
影响因子：
2
通讯作者：
Liang Peihe
中科院分区：
文献类型：
--
作者：
Hu Jian;Jin Dachun;Fan Runze;Xie Xiaodu;Zhou Zhihao;Chen Yanlin;Zhang Yao;Zhang Jun;Gao Liang;Jiang Jun;Zhang Yuanfeng;Liang Peihe
目的探讨急性肾损伤（AKI）持续时间和严重程度对肾部分切除术（PN）患者长期肾功能结局的影响。方法选取2010 - 2018年在两家医疗中心连续行腹腔镜PN手术的292例患者。此外，将AKI持续时间{短暂性AK[≤3d]或持续性AKI [> 3d]}与AKI严重程度（分期）相结合，以阐明其与长期功能结果的关系。Kaplan-Meier （KM）分析也用于比较无AKI、短暂性AKI和持续性AKI患者。此外，采用cox -比例风险回归模型评估肾功能恶化的危险因素。结果67例（22.9%）患者发生术后AKI。采用KM分析和log-rank检验比较无AKI、短暂性AKI和持续性AKI患者随访期间75%的eGFR保存率，差异有统计学意义。通过多变量模型比例风险分析调整年龄和热缺血时间后，AKI持续时间和严重程度被确定为危险因素(1期短暂性AKI vs.非AKI：调整风险比（HR） 4.361, 95%可信区间（CI） [2.062-9.233],p< 0.001；1期持续性AKI vs.非AKI：调整后HR 6.706, 95% CI [2.405-18.699],p< 0.001；2/3期短暂性AKI与非AKI：调整后危险度8.949,95% CI [1.571-50.963],p= 0.014；2/3期持续性AKI与非AKI：调整后危险度13.453,95% CI [11.353-133.798],p= 0.027)。结论肾移植术后AKI持续时间是肾功能长期恶化的重要危险因素。此外，AKI持续时间结合AKI严重程度可以更全面地了解AKI对最终肾功能的影响。中国临床试验：ChiCTR2000034080。
PurposeTo evaluate the effect of acute kidney injury (AKI) duration and severity on long-term renal functional outcomes in patients undergoing partial nephrectomy (PN).MethodsAltogether 292 consecutive patients undergoing laparoscopic PN from 2010 to 2018 were identified in two medical centers. In addition, the AKI duration {transient AK [≤ 3d] or persistent AKI [> 3d]} was combined with AKI severity (stages) to elucidate their relationships with long-term functional results. Kaplan–Meier (KM) analysis was also used to compare among patients with no AKI, transient AKI, and persistent AKI. Moreover, the Cox-proportional hazards regression model was utilized to assess the risk factors for renal function deterioration.ResultsAltogether 67 patients (22.9%) experienced postoperative AKI. 75% eGFR preserve rate during the follow-up was compared among patients with no AKI, transient AKI and persistent AKI using KM analysis and log-rank test, which revealed significant difference. After adjusting for age and warm ischemia time by multivariate model proportional hazards analysis, AKI duration and severity were identified as the risk factors (Stage 1-transient AKI vs. non-AKI: adjusted hazard ratio (HR) 4.361, 95% confidential interval (CI) [2.062–9.233],p< 0.001; stage 1-persistent AKI vs. non-AKI: adjusted HR 6.706, 95% CI [2.405–18.699],p< 0.001; stage 2/3-transient AKI vs. non-AKI: adjusted HR 8.949, 95% CI [1.571–50.963],p= 0.014; stage 2/3-persistent AKI vs. non-AKI: adjusted HR 13.453, 95% CI [11.353–133.798],p= 0.027).ConclusionsThe AKI duration after PN is an important risk factor for long-term renal functional deterioration. Besides, AKI duration combined with AKI severity can be more comprehensive to understand the role of AKI on ultimately renal function.Trial registrationChinese ClinicalTrials: ChiCTR2000034080.