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Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched

Na Young Kim1, Jung Hwa Hong2, Dong Hoon Koh3

  • 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. knnyyy@yuhs.ac.

Journal of Clinical Medicine
|April 10, 2019
PubMed

Insights

Diabetes mellitus increases the risk of acute kidney injury (AKI) after minimally invasive partial nephrectomy (PN). Male sex, longer warm ischemia time, and elevated hemoglobin A1c are key predictors of AKI in these patients.

Area of Science:

  • Nephrology
  • Urology
  • Surgical Outcomes

Background:

  • Postoperative acute kidney injury (AKI) remains a significant concern following partial nephrectomy (PN), even with advancements in minimally invasive techniques.
  • Diabetes mellitus (DM) is a prevalent comorbidity that may influence AKI risk after PN.

Purpose of the Study:

  • To compare the incidence of postoperative AKI in patients with and without DM undergoing PN.
  • To identify predictive factors for postoperative AKI in patients who underwent PN.

Main Methods:

  • A case-matched retrospective study involving 884 patients with preoperative creatinine levels ≤1.4 mg/dL who underwent laparoscopic or robot-assisted PN.
  • Propensity score matching was used to create comparable groups of patients with and without DM (1:3 ratio).
  • Multivariate analysis was performed to determine independent risk factors for AKI.

Main Results:

  • The overall incidence of postoperative AKI was 20.4%.
  • After propensity score matching, AKI incidence was significantly higher in the DM group (30.7%) compared to the non-DM group (14.9%) (P < 0.001).
  • Male sex and warm ischemia time (WIT) >25 min were associated with AKI in both groups. In patients with DM, hemoglobin A1c (HbA1c) >7% was a significant predictor (OR = 4.59).

Conclusions:

  • Diabetes mellitus is associated with an increased risk of AKI after minimally invasive PN.
  • Male sex, prolonged WIT, and elevated HbA1c are independent risk factors for AKI in patients with DM undergoing PN.
Keywords:
acute kidney injurydiabetes mellitusminimally invasive surgical proceduresnephrectomyrisk factors

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