No increase in chronic kidney disease after postoperative acute kidney injury in gynecologic oncologic ERAS surgery.

OBJECTIVE

To compare development of long-term chronic kidney disease (CKD) and cardiac conditions postoperatively among patients who did and did not develop acute kidney injury (AKI) after open ERAS surgery for gynecologic malignancy.

METHODS

We compared patients with and without postoperative AKI within 30 days of open surgery for gynecologic malignancies using ERAS protocols from March 2016-December 2018 at a single academic institution. We estimated 36-month cumulative incidence of renal and cardiac conditions for each cohort. We compared cohorts using comparative statistics and performed univariate and multivariate analyses on time to development of CKD.

RESULTS

Among 378 patients, 51 (13.5 %) developed postoperative AKI. Over a median follow-up of 19.4 months (range 0.1-59.2 months), patients with AKI were twice as likely to develop CKD (p < 0.001). There was no difference in development of any cardiac condition (p = 0.74) between patients with and without AKI. The cumulative incidence of CKD at 36 months was 23.4 %. On univariate analysis, patients with AKI were more likely to develop CKD (HR = 2.17, 95 % CI 1.22-3.84) but AKI was not significantly associated with CKD on multivariate analysis. Older age (p < 0.001), body mass index ≥30 kg/m2 (p = 0.048), hypertension (p = 0.042), higher preoperative creatinine (p < 0.001), and neoadjuvant chemotherapy (p = 0.037) were significantly associated with CKD in the multivariate model.

CONCLUSION

We found no differences in long-term renal or cardiac conditions between patients with and without postoperative AKI after open ERAS surgery for gynecologic malignancies. Factors other than postoperative AKI appear more important in CKD development in patients with gynecologic cancers.