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The relationships of acute kidney injury duration and severity with long-term functional deterioration following partial nephrectomy

  • Nephrology - Original Paper
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Abstract

Purpose

To evaluate the effect of acute kidney injury (AKI) duration and severity on long-term renal functional outcomes in patients undergoing partial nephrectomy (PN).

Methods

Altogether 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.

Results

Altogether 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).

Conclusions

The 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 registration

Chinese ClinicalTrials: ChiCTR2000034080.

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Funding

This work was supported by the Innovation Program For Chongqing’s Overseas Returnees (2019), High-level Meical Reserved Personnel Training Project Of Chongqing (the 4th bath), and Research Program of Basic Science and Frontier Technology in Chongqing (cstc2017jcyjAX0435), and National Natural Science Foundation of China (Grant No. 81801507), and by the Kuanren Talent Program of the Second Affiliated Hospital of Chongqing Medical University (KY2019Y004).

Author information

Author notes

  1. Jian Hu and Dachun Jin contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, No. 76, Linjiang Rd, Yuzhong District, Chongqing, 400010, China

    Jian Hu, Runze Fan, Xiaodu Xie, Zhihao Zhou, Yanlin Chen, Liang Gao, Yuanfeng Zhang & Peihe Liang

  2. Department of Urology, Daping Hospital/Army Medical Center of PLA, Army Medical University, Chongqing, 400042, China

    Dachun Jin, Yao Zhang, Jun Zhang & Jun Jiang

Authors
  1. Jian Hu
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  2. Dachun Jin
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  3. Runze Fan
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  4. Xiaodu Xie
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  5. Zhihao Zhou
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  6. Yanlin Chen
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  7. Yao Zhang
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  8. Jun Zhang
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  9. Liang Gao
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  10. Jun Jiang
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  11. Yuanfeng Zhang
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  12. Peihe Liang
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Contributions

JH [CO]: study design, data collection, data analysis, manuscript writing. DJ [CO]: study design, data collection, data analysis, manuscript writing. RF: data analysis, manuscript review. XX: data collection, manuscript review. ZZ: data collection, manuscript review. YC: data collection, manuscript review. YZ: study design, data collection. JZ: study design, data collection. LG: study design, data collection. JJ: study design, data collection, manuscript review. YZ: study design, data analysis, data collection, manuscript review. PL: data analysis, data collection, manuscript review.

Corresponding authors

Correspondence to Jun Jiang, Yuanfeng Zhang or Peihe Liang.

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Conflict of interest

This study has not been funded or supported by any company. All authors declare that they have no conflict of interest.

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Hu, J., Jin, D., Fan, R. et al. The relationships of acute kidney injury duration and severity with long-term functional deterioration following partial nephrectomy. Int Urol Nephrol 54, 1623–1628 (2022). https://doi.org/10.1007/s11255-021-03033-z

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  • DOI: https://doi.org/10.1007/s11255-021-03033-z

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