Acute kidney injury following radical nephrectomy and inferior vena cava thrombectomy: A tertiary referral center experience.

PURPOSE: To investigate the incidence and determine the risk factors associated with acute kidney injury (AKI) following radical nephrectomy with inferior vena cava (IVC) thrombectomy.

METHODS

We retrospectively reviewed the records of patients who underwent radical nephrectomy and IVC thrombectomy for renal cell carcinoma between 2000 and 2023. Patients on pre-existing renal replacement therapy were excluded. Postoperative AKI was diagnosed and classified into 3 stages according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression analysis was performed to evaluate the association between perioperative factors and the risk of developing moderate/severe AKI (KDIGO stage 2 or 3) following surgery. Renal function status at 90 days postoperatively was also evaluated in these patients.

RESULTS

A total of 155 patients were included in the analysis. Median (IQR) age of the cohort was 65 (59-71) years, and 105 of the patients (68%) were male. Following surgery, 104 patients (67%) developed AKI, including 74 (48%) stage 1, 19 (12%) stage 2, and 11 (7%) stage 3. On multivariable logistic regression analysis, adjusting for age, coronary artery disease, and body mass index (BMI), obesity (BMI ≥ 30 kg/m2) was associated with a significantly higher rate of moderate or severe AKI following surgery (odds ratio 3.02, P = 0.02). Within the 90-day follow-up of patients with moderate/severe AKI, only 1 required dialysis.

CONCLUSIONS

AKI is common after radical nephrectomy and IVC thrombectomy; however, most cases are mild and do not require dialysis. Obesity is associated with an increased risk of moderate to severe AKI following surgery.