Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory

Abstract

BackgroundThe present study aimed to assess the impact of perioperative fluid management on early acute kidney injury (AKI) rate and long-term sequelae in patients undergoing elective colorectal procedures within an enhanced recovery pathway (ERP).MethodsRetrospective analysis of consecutive patients from a prospectively maintained ERP database (2011–2015) is performed. Pre- and postoperative creatinine levels (within 24\xa0h) were compared according to risk (preoperative creatinine rise\u2009×1.5), injury (×2), failure (×3), loss of kidney function and end-stage kidney disease (RIFLE) criteria. Risk factors for early AKI were identified through logistic regression analysis, and long-term outcome in patients with AKI was assessed.ResultsOut of 7103 patients, 4096 patients (58%) with pre- and postoperative creatinine levels were included. Of these, 104 patients (2.5%) presented postoperative AKI. AKI patients received higher amounts of POD 0 fluids (3.8\u2009±\u20092.4 vs. 3.2\u2009±\u20092 L, p\u2009=\u20090.01) and had increased postoperative weight gain at POD 2 (6\u2009±\u20094.9 vs. 3\u2009±\u20092.7\xa0kg, p\u2009=\u20090.007). Independent risk factors for AKI were high ASA score (ASA\u2009≥\u20093: OR 1.7; 95% CI 1.1–2.5), prolonged operating time (>180\xa0min: OR 1.9; 95% CI 1.3–2.9) and diabetes mellitus (OR 2.5; 95% CI 1.5–4), while minimally invasive surgery was a protective factor (OR 0.6; 95% CI 0.4–0.9). Five patients (0.1%) developed chronic kidney disease, and two of them needed dialysis after a mean follow-up of 33.7\u2009±\u200922.4\xa0months.ConclusionsEarly AKI was very uncommon in the present cohort of colorectal surgery patients treated within an ERP, and long-term sequelae were exceptionally low.