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Sci Rep. 2019 Jan 24;9(1):760. doi: 10.1038/s41598-018-37432-7.

The association between intraoperative urine output and postoperative acute kidney injury differs between partial and radical nephrectomy.

Author information

1
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
2
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
3
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. wonhokim.ane@gmail.com.

Abstract

We sought to investigate the association between intraoperative urine output and postoperative acute kidney injury (AKI) in patients undergoing radical and partial nephrectomy. We retrospectively reviewed data of 742 patients. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. The relationship between intraoperative urine output and the risk of AKI was evaluated by multivariable logistic regression analysis in radical and partial nephrectomy, separately. Minimum P-value approach was used to find the optimal threshold of intraoperative oliguria associated with the risk of AKI. The incidence of AKI was 14.4% (67/466) after partial nephrectomy and 57.6% (159/276) after radical nephrectomy. For partial nephrectomy, multivariable analysis showed that renal ischemic time, operation time, open surgery and intraoperative transfusion were significantly associated with AKI. For radical nephrectomy, history of hypertension, baseline glomerular filtration rate and intraoperative mean urine output were significantly associated with AKI. Intraoperative mean urine output during radical nephrectomy was associated with AKI after radical nephrectomy, while not after partial nephrectomy. Mean urine output <1.0 mL/kg/h was determined to be an optimal cutoff of AKI after radical nephrectomy. Intraoperative oliguria may have different clinical implication for AKI between partial and radical nephrectomy.

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