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The impact of perioperative positive fluid balance on postoperative acute kidney injury in patients undergoing open hepatectomy: A retrospective single center cohort study

  • 0Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Plos One +

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April 1, 2025

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April 1, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Maintaining a 1-2 liter fluid balance during hepatectomy is key to preventing acute kidney injury (AKI). Fluid balances over 2 liters significantly increase AKI risk in liver surgery patients.

Area Of Science

  • Hepatobiliary Surgery
  • Nephrology
  • Critical Care Medicine

Background

  • Fluid management strategies like low central venous pressure (CVP) are used in liver resection to reduce blood loss.
  • However, both hypovolemia and excessive fluid administration can negatively impact organ perfusion, raising the risk of renal dysfunction and acute kidney injury (AKI).
  • This study investigates the link between perioperative fluid management and renal outcomes in hepatectomy patients.

Purpose Of The Study

  • To explore the relationship between perioperative fluid management strategies and renal outcomes in patients undergoing hepatectomy.
  • To determine the optimal fluid balance range for minimizing AKI risk during liver surgery.
  • To identify other risk factors associated with post-hepatectomy AKI.

Main Methods

  • A retrospective single-center cohort study of 691 patients undergoing open hepatectomy.
  • Patients were stratified into three groups based on positive fluid balance: <1 Liter, 1-2 Liters, and >2 Liters.
  • Propensity score matching was employed, and multivariable logistic regression analyzed the correlation between fluid balance and AKI risk.

Main Results

  • The overall incidence of AKI was 11.58%, with the highest rate in the >2 Liter fluid balance group.
  • A fluid balance >2 Liters was associated with a significantly higher relative risk of AKI (adjusted RR 1.85, p = 0.042).
  • Increased fluid balance correlated with a higher AKI incidence rate ratio (p = 0.016), alongside operating time >5 hours, blood loss >1000 ml, and advanced liver disease (Child-Turcotte-Pugh B/C).

Conclusions

  • Maintaining a perioperative fluid balance of 1-2 liters during hepatectomy is critical for reducing postoperative AKI.
  • Fluid balances exceeding 2 liters significantly elevate AKI risk.
  • Careful fluid management, alongside consideration of operating time, blood loss, and liver disease severity, is essential for mitigating AKI risk in hepatectomy patients.