Acute kidney injury prevalence in patients with colorectal cancer undergoing surgery with curative intent

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

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Goal-directed hemodynamic therapy in patients with colorectal cancer undergoing laparoscopic surgery

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2020-16-1-29-36 ◽

2020 ◽

Vol 16 (1) ◽

pp. 29-36

Author(s):

V. A. Panaﬁdina ◽

I. V. Shlyk

Keyword(s):

Colorectal Cancer ◽

Acute Kidney Injury ◽

Cardiac Output ◽

Perfusion Pressure ◽

Kidney Injury ◽

Control Group ◽

Hemodynamic Management ◽

Goal Directed Therapy ◽

Non Invasive ◽

Hemodynamic Therapy

Introduction. The conductance of goal-directed hemodynamic therapy is controversial due to the difficulty in its implementation in routine practice despite the signiﬁcant number of studies and meta-analyses.Objective. To estimate the efficacy of a modiﬁed algorithm of goal-directed hemodynamic management in patients with colorectal cancer who undergo laparoscopic surgery based on non-invasive monitoring of cardiac output.Subjects and methods. A single-centered, randomized trial was conducted. The control group included 75 patients, while the goal-directed therapy (GDT) group included 72 patients. In the control group, hemodynamic management was based on mean arterial pressure and intraabdominal perfusion pressure. In addition, results of ﬂuid responsiveness tests were considered in the GDT group. The suggested protocol efficacy was evaluated on the basis of frequency of critical incidents, shifts in acid-base balance and lactate concentration, infusion volume, vasopressor doses, the incidence of acute kidney injury, and other complications.Results. After anesthesia induction and according to the results of a modiﬁed, passive leg raising test, 67.1% of patients were considered responders and received 1250 (1000; 1500) ml of balanced crystalloids before carboxyperitoneum. The infusion differentiation test of hypotension cause was performed in 47 patients of the GDT group, 37% were considered responders, and others received vasopressors and/or inotropes. The use of the GDT protocol led to a decrease in total infusion volume and vasopressor doses. A lower frequency of critical incidents was recorded when the GDT protocol was used. In the GDT group, there were no signs of ischemia and increased frequency of complications (including acute kidney injury).Conclusions. Testing of ﬂuid responsiveness and non-invasive cardiac output monitoring allows for the correction of hemodynamics during surgery. Goal-directed therapy in the intraoperative period allows different approaches to maintaining systemic and intraabdominal perfusion pressure, thus decreasing the total volume of infusion without increasing hypoperfusion risk.

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Comparison of the Effects of Laparoscopic and Open Surgery on Postoperative Acute Kidney Injury in Patients with Colorectal Cancer: Propensity Score Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10071438 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1438

Author(s):

Ji Hoon Sim ◽

Sa-Jin Kang ◽

Ji-Yeon Bang ◽

Jun-Gol Song

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Acute Kidney Injury ◽

Laparoscopic Surgery ◽

Propensity Score ◽

Hospital Stay ◽

Open Surgery ◽

Kidney Injury ◽

Icu Admission ◽

Postoperative Aki

Postoperative acute kidney injury (AKI) is a serious complication that increases patient morbidity and mortality. However, few studies have evaluated the effect of laparoscopic surgery on postoperative AKI. This study compared the incidence of postoperative AKI between laparoscopic and open surgery in patients with colorectal cancer. This study retrospectively analyzed 3637 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into laparoscopic (n = 987) and open (n = 2650) surgery groups. We performed multivariable regression analysis to assess the risk factors for AKI and propensity score matching analysis to compare the incidence of AKI between the two groups. We also assessed postoperative intensive care unit (ICU) admission, complications, hospital stay, and 1-year mortality. We observed no significant differences in the incidence of postoperative AKI between the two groups before (8.8% vs. 9.1%, p = 0.406) and after (8.8% vs. 7.7%, p = 0.406) matching. Laparoscopic surgery was not associated with AKI even after adjusting for intraoperative variables (adjusted odds ratio (OR): 1.17, 95% confidence interval (CI): 0.84–1.62, p = 0.355). Body mass index, diabetes mellitus, hypertension, and albumin were risk factors for AKI. ICU admission (0.6% vs. 2.5%, p = 0.001), complications (0.2% vs. 1.5%, p = 0.002), hospital stay (6.89 days vs. 8.61 days, p < 0.001), and 1-year mortality (0.1% vs. 0.9%, p = 0.021) were significantly better in the laparoscopic than in the open group. The incidence of postoperative AKI did not differ significantly between laparoscopic and open surgery. However, considering its better surgical outcomes, laparoscopic surgery may be recommended for patients with colorectal cancer.

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Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer

International Journal of Molecular Sciences ◽

10.3390/ijms22094618 ◽

2021 ◽

Vol 22 (9) ◽

pp. 4618

Author(s):

Joanna Jagieła ◽

Piotr Bartnicki ◽

Jacek Rysz

Keyword(s):

Colorectal Cancer ◽

Lung Cancer ◽

Acute Kidney Injury ◽

Small Cell Lung Cancer ◽

Kidney Injury ◽

Chemotherapeutic Agents ◽

Small Cell ◽

Small Cell Lung ◽

Oncological Treatment ◽

Renal Complications

Acute kidney injury is a common complication of many medical procedures, including those used in cancer treatment. Both chemotherapy and immunotherapy may result in deterioration of kidney function, which may lead to an increase in mortality among patients with cancer. Antineoplastic agents can affect any element of the nephron, leading to the appearance of clinical symptoms such as proteinuria, hypertension, electrolyte disorders, glomerulonephritis, acute and chronic interstitial nephritis and acute kidney injury. The medical literature describing renal complications occurring during chemotherapeutic and immunotherapeutic treatment in neoplasms, such as colorectal cancer, non-small cell lung cancer and melanoma, was analysed. The immune system plays an important role in controlling the development of neoplasms and fighting them. Oncological treatment algorithms include immunotherapy as monotherapy, combined with chemotherapy or chemotherapy as monotherapy. In the treatment of the above-mentioned neoplasms immunotherapeutics are used, such as checkpoint inhibitors (CPI) (i.e., ipilimumab, pembrolizumab, nivolumab, atezolizumab), vascular endothelial growth factor (VEGF) inhibitors (i.e., bevacizumab, ramucirumab) and a variety of chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, gefitinib, erlotinib, gemcitabine, cisplatin, paclitaxel, carboplatin, doclitaxel, vinorelbine, topotecan, etoposide). In our article, we focused on the number and type of renal complications as well as on the time of their manifestation when using specific treatment regimens. Our analysis also includes case reports. We discussed treatment of immunological complications and adjustments of the dose of chemotherapeutic agents depending on the creatinine clearance. Analysing the data from the literature, when two immunotherapeutic agents are used together, the number of recorded renal complications increases. Bevacizumab and ramucirumab are the cause of the largest number of renal complications among the immunotherapeutic agents described above. Cisplatin is the best-described substance with the greatest nephrotoxic potential among the chemotherapeutic agents. Crucial for renal complications are also cancer stage, previous chemotherapy and other risk factors of AKI such as age, comorbidities and medications used. Due to the described complications during oncological treatment, including kidney damage, it seems necessary to elaborate standards of cooperation between oncologists and nephrologists both during and after treatment of a patient with cancer. Therefore, it is necessary to conduct further research and develop algorithms for management of a cancer patient, especially during such an intensive progress in oncology.

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Ileostomy creation in colorectal cancer surgery: risk of acute kidney injury and chronic kidney disease

Journal of Surgical Research ◽

10.1016/j.jss.2016.11.039 ◽

2017 ◽

Vol 210 ◽

pp. 204-212 ◽

Cited By ~ 13

Author(s):

Linda Li ◽

Kelsey S. Lau ◽

Venkat Ramanathan ◽

Sonia T. Orcutt ◽

Shubhada Sansgiry ◽

...

Keyword(s):

Colorectal Cancer ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Cancer Surgery ◽

Colorectal Cancer Surgery

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Acute kidney injury and 1-year mortality after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-024817 ◽

2019 ◽

Vol 9 (3) ◽

pp. e024817 ◽

Cited By ~ 7

Author(s):

Charlotte Slagelse ◽

Henrik Gammelager ◽

Lene Hjerrild Iversen ◽

Henrik Toft Sørensen ◽

Christian F Christiansen

Keyword(s):

Colorectal Cancer ◽

Acute Kidney Injury ◽

Cohort Study ◽

Postoperative Complication ◽

Kidney Injury ◽

Population Based ◽

Colorectal Cancer Surgery ◽

Absolute Increase ◽

Cancer Group ◽

The Impact

ObjectivesAcute kidney injury (AKI) is a frequent postoperative complication, but the mortality impact within different postoperative time frames and severities of AKI are poorly understood. We examined the occurrence of postoperative AKI among colorectal cancer (CRC) surgery patients and the impact of AKI on mortality during 1 year after surgery.DesignObservational cohort study. We defined the exposure, AKI, as a 50% increase in plasma creatinine or initiation of renal replacement therapy within 7 days after surgery or an absolute increase in creatinine of 26 µmol/L within 48 hours.SettingPopulation-based Danish medical databases.ParticipantsA total of 6580 patients undergoing CRC surgery in Northern Denmark during 2005–2011 were included from the Danish Colorectal Cancer Group database.Outcomes measureOccurrence of AKI and 8–30, 31–90 and 91–365 days mortality in patient with or without AKI.ResultsAKI occurred in 1337 patients (20.3%) of the 6580 patients who underwent CRC surgery. Among patients with AKI, 8–30, 31–90 and 91–365 days mortality rates were 10.1% (95% CI 8.6% to 11.9%), 7.8% (95% CI 6.4% to 9.5%) and 12.0% (95% CI 10.3% to 14.2%), respectively. Compared with patients without AKI, AKI was associated with increased 8–30 days mortality (adjusted HR (aHR)=4.01,95% CI 3.11 to 5.17) and 31–90 days mortality (aHR 2.08,95% CI 1.60 to 2.69), while 91–365 days aHR was 1.12 (95% CI 0.89 to 1.41). We observed no major differences in stratified analyses.ConclusionsAKI after surgery for CRC is a frequent postoperative complication associated with a substantially increased 90-day mortality. AKI should be considered a potential target for reducing 90-day mortality.

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