Postoperative Acute Kidney Injury
Conditions
Keywords
liver resection, elderly, renal oxygen saturation, near-infrared spectroscopy
Brief summary
The aim of this study is to investigate the changes in renal regional oxygen saturation (rSO2) monitored by near-infrared spectroscopy (NIRS) and its relationship with the occurrence of postoperative AKI.
Detailed description
Postoperative acute kidney injury (AKI) is a severe complication after liver resection and contributes to increased morbidity and mortality. Advanced age reduces renal autoregulatory capacity due to physiological and functional changes, thus render the elderly to suffer postoperative AKI and probably the consequent chronic kidney disease. Thus, it is essential to identify those patients at high risk to develop postoperative AKI to optimize perioperative prevention and protection strategies. Despite the multiple risk factors and potential mechanisms that have been identified, the diagnosis of postoperative AKI depending on serum creatinine changes have been delayed for early identification of postoperative AKI. It is of great interest to develop target strategies for close motoring of renal function. This study is a prospective cohort study to investigate the associations between intraoperative renal desaturation measured by NIRS and postoperative AKI. The investigators intend to access the optimal threshold values of renal rSO2 for predicting postoperative AKI. Desaturation of renal rSO2 will be defined by the severity and duration of NIRS values during the surgical process. The principal clinical outcome of the study is postoperative AKI, defined as an absolute increase in serum creatinine of 0.3 mg/dL within 48 hours or a 1.5-fold increase from preoperative baseline within seven days after surgery, according to the Kidney Disease: Improving Global Outcomes (KDIGO) criterion.
Interventions
DEVICENear-infrared spectroscopy
Before the induction of anesthesia, NIRS sensors were placed on both sides of the flank area that overlies the kidney to monitor renal SO2, whose alteration trends over time during operation will be recorded and evaluated in later analysis.
Sponsors
Beijing Tsinghua Changgeng Hospital
Chinese PLA General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Elderly patients (defined as 60 years of age or older) scheduled for elective liver resection
Exclusion criteria
* Emergency surgery * Liver transplantation * Preoperative hemodialysis * BMI \> 30 * Renal depth (distance from the capsule of the kidney to the skin surface) \> 4 cm * Unable or failed to sign the informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative acute kidney injury | Postoperative 7 days | Postoperative acute kidney injury is defined according to the KDIGO criterion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Death before and 30 days after discharge | 30 days after discharge | Collection of clinical data in the medical record and follow-up update through telephone |
| Length of hospital stay | Postoperative 30 days | Collection of clinical data in the medical record |
Countries
China
Outcome results
None listed