Association between preoperative hydration status and acute kidney injury in patients managed surgically for kidney tumours.

Autor: Ellis RJ; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia. r.ellis1@uq.edu.au.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia. r.ellis1@uq.edu.au.; Princess Alexandra Hospital, Brisbane, Australia. r.ellis1@uq.edu.au., Del Vecchio SJ; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia., Kalma B; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia., Ng KL; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia., Morais C; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia., Francis RS; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia., Gobe GC; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia.; NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia., Ferris R; Princess Alexandra Hospital, Brisbane, Australia., Wood ST; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.; Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, Australia.; Princess Alexandra Hospital, Brisbane, Australia.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2018 Jul; Vol. 50 (7), pp. 1211-1217. Date of Electronic Publication: 2018 Jun 05.
DOI: 10.1007/s11255-018-1901-2
Abstrakt: Purpose: The purpose of this study was to investigate whether preoperative dehydration and intraoperative hypotension were associated with postoperative acute kidney injury in patients managed surgically for kidney tumours.
Methods: A retrospective analysis of 184 patients who underwent nephrectomy at a single centre was performed, investigating associations between acute kidney injury after nephrectomy, and both intraoperative hypotension and preoperative hydration/volume status. Intraoperative hypotension was defined as mean arterial pressure < 60 mmHg for ≥ 5 min. Urine conductivity was evaluated as a surrogate measure of preoperative hydration (euhydrated < 15 mS/cm; mildly dehydrated 15-20 mS/cm; dehydrated > 20 mS/cm). Multivariable logistic regression was used to evaluate associations between exposures and the primary outcome, with adjustment made for potential confounders.
Results: Patients who were dehydrated and mildly dehydrated had an increased risk of acute kidney injury (adjusted odds ratio [aOR] 4.1, 95% CI 1.3-13.5; and aOR 2.4, 95% CI 1.1-5.3, respectively) compared with euhydrated patients (p = 0.009). Surgical approach appeared to modify this effect, where dehydrated patients undergoing laparoscopic surgery were most likely to develop acute kidney injury, compared with patients managed using an open approach. Intraoperative hypotension was not associated with acute kidney injury.
Conclusion: Preoperative dehydration may be associated with postoperative acute kidney injury. Avoiding dehydration in the preoperative period may be advisable, and adherence to international evidence-based guidelines on preoperative fasting is recommended.
Databáze: MEDLINE
Externí odkaz: