Analysis of factors influencing the grading of acute kidney injury in patients with malignant renal tumors after partial nephrectomy

Abstract

Objective To investigate the influencing factors of the grading of acute kidney injury （AKI） caused by partial nephrectomy in patients with malignant renal tumors. Methods General information， surgery and treatment data， clinical and pathological grading， laboratory test results， surgical records and pathological reports and other clinical data of patients with malignant renal tumors who underwent partial nephrectomy in Qingdao Municipal Hospital from January 2013 to January 2023 were collected. All patients were divided into the non-AKI， stage1 and stage 2 AKI groups according to the incidence of AKI. The influencing factors of AKI were identified by Logistic regression analysis. The efficiency of serum creatinine in predicting AKI after partial nephrectomy was analyzed by the receiver operating characteristic （ROC） curve. Results A total of 503 patients with malignant renal tumors underwent partial nephrectomy， including 378 cases （75.1%） of non-AKI， 83 cases （16.5%） of stage 1 AKI and 42 cases （8.3%） of stage 2 AKI， respectively. Patients with stage 1 AKI showed statistically significant differences in the proportion of hypertension and diabetes mellitus， changes of creatinine levels at preoperative 48 h， tumor volume， warm ischemia time， and body mass index （BMI） compared with non-AKI counterparts （all P <0.05）. Patients with stage 2 AKI showed statistically significant differences in the gender composition， proportion of hypertension and diabetes mellitus， R.E.N.A.L. score， changes of creatinine levels at preoperative 48 h，tumor volume， warm ischemia time and BMI compared with AKI counterparts （all P <0.05）. Logistic regression analysis revealed that the influencing factors of stage 1 AKI after partial nephrectomy included BMI， hypertension， diabetes mellitus， the changes of serum creatinine levels at preoperative 48 h， tumor volume and warm ischemia time， and the influencing factors of stage 2 AKI also consisted of gender and R.E.N.A.L score （all P <0.05）. The cutoff values of serum creatinine levels for the diagnosis of AKI and stage 2 AKI were 23.29 and 39.88 mmol/L， with a sensitivity of 98.1% and 99.8%， a specificity of 81.3% and 89.6%， and an area under the ROC curve （AUC） of 0.969 and 0.974， respectively. Conclusions The influencing factors for AKI after partial nephrectomy in patients with malignant renal tumors are hypertension， diabetes mellitus， changes in creatinine levels at preoperative 48 h， tumor volume， warm ischemia time and BMI. In addition， the influencing factors for patients with stage 2 AKI consist of gender and R.E.N.A.L. score. Early identification of these influencing factors and active interventions can reduce the incidence of postoperative AKI and alleviate the severity of AKI.

Keywords

• malignant renal tumor|partial nephrectomy|acute kidney injury|influencing factor|hypertension|diabetes mellitus