Risk factors for acute kidney injury after partial hepatectomy

Table 1 Postoperative overall complications and acute kidney injury staging according to International Club of Ascites[11], risk, injury, failure, loss, end-stage[27] and Acute Kidney Injury Network[28] criteria (n = 446) n (%)

Overall complications	113 (25.3)
Overall complications (Clavien-Dindo classification)
I	46 (10.3)
II	25 (5.6)
III a/b	18 (4.0)
IV a/b	7 (1.6)
V (death)	17 (3.8)
AKI (ICA)	80 (17.9)
I	26 (5.8)
II	21 (4.7)
III	33 (7.4)
AKI (RIFLE)	70 (15.7)
Risk	16 (3.6)
Injury	21 (4.7)
Failure	33 (7.4)
AKI (AKIN)	80 (17.9)
I	26 (5.8)
II	21 (4.7)
III	32 (7.2)
HRS	11 (2.5)
RRT (hemodyalises)	9 (2.0)

AKI: Acute kidney injury; ICA: International Club of Ascites; RIFLE: Risk, injury, failure, loss, end-stage; AKIN: Acute Kidney Injury Network; HRS: Hepatorenal syndrome; RRT: Renal replacement therapy.

Table 2 Preoperative patient characteristics according to the occurrence of postoperative acute kidney injury in 466 partial hepatectomies n (%)

	No AKI (n = 366)	AKI (n = 80)	P
Gender, male	180 (49.2)	43 (53.8)	0.269
Age (years), mean (SD)	54.6 (16.57)	57.4 (16.10)	0.842
ACE inhibitors	19 (5.2)	10 (12.5)	0.210
NSAIDs	26 (7.1)	10 (12.5)	0.082
Non-dialytic CKI	1 (0.27)	8 (10.0)	< 0.001
Diabetes mellitus	44 (12.0)	14 (17.5)	0.121
Systemic arterial hypertension	70 (19.1)	15 (18.8)	0.467
Preoperative chemotherapy	85 (23.2)	24 (30.0)	0.402
Cirrhosis	23 (6.3)	10 (12.5)	0.042
MELD score, mean (SD)	7.67 (1.15)	8.05 (1.05)	0.020
Biliary obstruction	6 (1.6)	13 (16.2)	< 0.001
Baseline laboratory tests
Serum urea (mg/dL), mean ± SD	31.45 ± 10.71	35.63 ± 23.77	0.021
Serum creatinine (mg/dL), mean ± SD	0.90 ± 0.71	0.98 ± 0.62	0.229
eGFR (mL/min per square meter), mean ± SD	98.38 ± 51.32	89.86 ± 35.46	0.944
Sodium (mEq/L), mean ± SD	135.67 ± 3.25	134.25 ± 3.00	0.350
Potassium (mEq/L), mean ± SD	4.44 ± 0.63	4.34 ± 0.75	0.697
INR, mean ± SD	1.13 ± 0.45	1.14 ± 0.20	0.912
Bilirrubin (mg/dL), mean ± SD	1.63 ± 3.05	2.84 ± 3.95	0.002
Albumin (g/dL), mean ± SD	3.61 ± 0.87	3.41 ± 0.92	0.505
Platelets (mm3), mean ± SD	211869.55 ± 103744.67	215522.81 ± 115186.57	0.129

AKI: Acute kidney injury; ACE: Angiotensin conversion enzyme; NSAIDs: Non-steroidal anti-inflamatory drugs; CKI: Chronic kidney injury; MELD: Model for End-Stage Liver Disease; INR: International normalized ratio.

Table 3 Intraoperative characteristics of the 446 liver resections according to the occurrence of postoperative acute kidney injury n (%)

	No AKI (n = 366)	AKI (n = 80)	P
Surgical approach			0.071
Open	343 (93.7)	79 (98.8)
Laparoscopic	23 (6.3)	1 (1.2)
Extention of resection			0.002
Major resection	128 (35.2)	45 (56.2)
Minor resection	238 (64.8)	35 (43.8)
Tumoral histology			0.134
Benign	70 (19.1)	6 (7.5)
Malignant	296 (80.9)	74 (92.5)
Segment I resection	23 (6.3)	8 (10.0)	0.098
Two-stage hepatectomy	26 (7.1)	6 (7.5)	0.439
Intermitent Pringle maneuver (15’\5’)	124 (33.9)	31 (38.8)	0.438
Continuous Pringle maneuver	26 (7.1)	10 (12.5)	0.254
Total vascular exclusion	6 (1.6)	2 (2.5)	0.212
Complex vascular reconstruction	6 (1.6)	1 (1.2)	0.634
Regional lymphadenectomy	86 (23.5)	25 (31.2)	0.155
Associated extrahepatic resection	27 (7.4)	10 (12.5)	0.103
Intraoperative instability	26 (7.1)	25 (31.2)	< 0.001
Red blood cell transfusion	31(8.5)	23 (28.8)	< 0.001

AKI: Acute kidney injury.

Table 4 Postoperative laboratory tests values and complications after 466 partial hepatectomies according to the occurrence of postoperative acute kidney injury n (%)

	No AKI (n = 366)	AKI (n = 80)	P
Laboratoty tests
Serum urea (mg/dL), mean ± SD	47.61 ± 49.36	82.19 ± 77.45	< 0.001
Serum creatinine (mg/dL), mean ± SD	1.29 ± 1.16	2.29 ± 2.21	< 0.001
eGFR (ml/min/m2), mean ± SD	83.24 ± 60.04	53.73 ± 34.38	< 0.001
Sodium (mEq/L), mean ± SD	132.88 ± 4.27	132.29 ± 5.55	0.385
Potassium (mEq/L), mean ± SD	4.86 ± 0.81	5.16 ± 0.94	0.013
INR, mean ± SD	1.82 ± 2.46	2.08 ± 1.161	0.438
Bilirrubin (mg/dL), mean ± SD	3.46 ± 4.54	4.54 ± 6.84	0.001
Albumin (g/dL), mean ± SD	2.58 ± 0.62	2.36 ± 0.59	0.069
Platelets (mm3), mean ± SD	144101.93 ± 120446.829	132906.89 ± 113193.18	0.518
Aminoglycosides	7 (1.9)	3 (3.8)	0.341
PHLF	7 (1.9)	21 (26.3)	< 0.001
A	4 (1.1)	3 (3.8)
B	3 (0.8)	10 (12.5)
C	0 (0)	8 (10.0)
PHH	1 (0.3)	9 (11.3)	< 0.001
A	0 (0)	2 (2.5)
B	0 (0)	4 (5.0)
C	1 (0.3)	3 (3.8)
Biliary fistula	25 (6.8)	10 (12.5)	0.086
A	15 (4.1)	6 (7.5)
B	7 (1.9)	3 (3.8)
C	3 (0.8)	1 (1.2)
Postoperative ascites	58 (15.9)	23 (28.8)	0.059
Wound infection	13 (3.6)	7 (8.8)	0.062
Pulmonary complications	15 (4.1)	6 (7.5)	0.177
Cardiovascular complications	7 (1.9)	2 (2.5)	0.501
Sepsis	2 (0.5)	13 (16.2)	< 0.001
Hospital stay (d), mean ± SD	6.68 ± 3.65	12.20 ± 9.41	0.008

AKI: Acute kidney injury; eGFR: Estimated glomerular filtration rate; PHLF: Post-hepatectomy liver failure; PHH: Post-hepatectomy haemorrhage.

Table 5 Univariate and logistic regression analyses of risk factors for acute kidney injury

Univariate analyses	Multiple logistic regression
	P	OR	95%CI		P
Extent of resection	0.002	2.249	1.217	4.156	0.010
Biliary obstruction	< 0.001	10.240	3.094	33.891	< 0.001
Hemodynamics instability	< 0.001	5.244	1.337	20.568	0.017
Red blood cell transfusion	< 0.001				0.244
Cirrhosis	0.042				0.241
MELD score	0.020	4.342	1.347	15.654	0.046
Sepsis	< 0.001	11.609	3.185	39.911	< 0.001
Posthepatectomy haemorrhage	< 0.001	12.652	7.769	53.612	< 0.001
CKI	< 0.001	8.975	1.533	44.675	0.022

AKI: Acute kidney injury; OR: Odds ratio; MELD: Model for End-Stage Liver Disease; CKI: Chronic kidney injury.