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Predictors of acute kidney injury after lung resection surgery: a retrospective case-control study

Prédicteurs d’insuffisance rénale aiguë après une chirurgie de résection pulmonaire : une étude cas témoins rétrospective

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Abstract

Purpose

Patients undergoing lung resection are at increased risk for acute kidney injury (AKI) in the immediate postoperative period, with important consequences for longer term morbidity and mortality. Lung resection surgery has unique considerations that could increase the risk of AKI, including lung resection volume, duration of one-lung ventilation (OLV), and intraoperative fluid restriction. Yet, specific risk factor data are lacking. The objective of this study was to identify independent risk factors for early AKI after lung resection surgery.

Methods

We conducted a retrospective case-control study of all patients presenting for elective lung resection surgery at an academic medical centre over a four-year period. Cases were patients who experienced an AKI and control patients were those who did not experience an AKI, based on KDIGO criteria. Baseline demographics and comorbidities along with duration of OLV and amount of lung resected were collected by retrospective chart review. The data were analyzed using multivariable logistic regression to identify independent predictors of AKI.

Results

Acute kidney injury occurred within 48 hr in 57/1,045 (5.5%; 95% confidence interval, 4.2 to 7.0) of patients. On multivariable analysis, our model of best fit included preoperative serum creatinine, male sex, use of angiotensin II receptor blockers, and duration of OLV. The rate of complications, intensive care unit admission, and risk of death were all higher in the group of patients who experienced AKI.

Conclusions

Acute kidney injury occurs frequently after lung resection surgery and is associated with increased risk of postoperative complications. Increased duration of OLV may be a risk factor for AKI in this population.

Résumé

Objectif

Les patient·es bénéficiant d’une résection pulmonaire courent un risque accru d’insuffisance rénale aiguë (IRA) en période postopératoire immédiate, avec des conséquences importantes pour la morbidité et la mortalité à long terme. La chirurgie de résection pulmonaire entraîne des considérations uniques qui pourraient augmenter le risque d’IRA, notamment le volume de la résection pulmonaire, la durée de la ventilation unipulmonaire (VUP) et la restriction liquidienne peropératoire. Pourtant, les données spécifiques sur les facteurs de risque font défaut. L’objectif de cette étude était d’identifier les facteurs de risque indépendants d’IRA précoce après une chirurgie de résection pulmonaire.

Méthode

Nous avons mené une étude cas témoins rétrospective de toute la patientèle se présentant pour une chirurgie de résection pulmonaire non urgente dans un centre médical universitaire sur une période de quatre ans. Les cas étaient des patient·es qui ont présenté une IRA et des patient·es témoins qui n’ont pas eu d’IRA, selon les critères KDIGO. Les données démographiques et les comorbidités de base ainsi que la durée de la VUP et le volume de poumon réséqué ont été recueillis par examen rétrospectif des dossiers. Les données ont été analysées à l’aide d’une régression logistique multivariée afin d’identifier des prédicteurs indépendants d’IRA.

Résultats

Une insuffisance rénale aiguë est survenue dans les premières 48 heures postopératoires chez 57/1045 (5,5 %; intervalle de confiance à 95 %, 4,2 à 7,0) des patient·es. Sur l’analyse multivariée, notre modèle de meilleur ajustement incluait la créatininémie préopératoire, le sexe masculin, l’utilisation d’antagonistes des récepteurs de l’angiotensine II et la durée de la VUP. Le taux de complications, l’admission en unité de soins intensifs et le risque de décès étaient tous plus élevés dans le groupe de patient·es ayant présenté une IRA.

Conclusion

L’insuffisance rénale aiguë survient fréquemment après une chirurgie de résection pulmonaire et est associée à un risque accru de complications postopératoires. Une durée prolongée de VUP pourrait constituer un facteur de risque d’IRA dans cette population.

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Author contributions

Ethan Bohn contributed to the conception and design of the study, preparation of the manuscript, and was responsible for the acquisition of data. Sadeesh Srinathan was responsible for study design and contributed to the interpretation of data and drafting the article. Joel Adu-Quaye contributed to the acquisition of data. Duane Funk contributed to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data and drafting the article.

Disclosures

None.

Funding statement

Dr. Funk is funded by the Beckstead Anesthesiology Professorship.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada

    Ethan Bohn MD, Joel Adu-Quaye BSc & Duane Funk MD

  2. Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Sadeesh Srinathan MD

  3. Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Duane Funk MD

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  1. Ethan Bohn MD
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Correspondence to Duane Funk MD.

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Bohn, E., Srinathan, S., Adu-Quaye, J. et al. Predictors of acute kidney injury after lung resection surgery: a retrospective case-control study. Can J Anesth/J Can Anesth 70, 1901–1908 (2023). https://doi.org/10.1007/s12630-023-02602-3

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