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2015 ; 17
(3
): 258-64
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Renal function after low central venous pressure-assisted liver resection:
assessment of 2116 cases
#MMPMID25387727
Correa-Gallego C
; Berman A
; Denis SC
; Langdon-Embry L
; O'Connor D
; Arslan-Carlon V
; Kingham TP
; D'Angelica MI
; Allen PJ
; Fong Y
; DeMatteo RP
; Jarnagin WR
; Melendez J
; Fischer M
HPB (Oxford)
2015[Mar]; 17
(3
): 258-64
PMID25387727
show ga
OBJECTIVES: Low central venous pressure (LCVP)-assisted hepatectomy is associated
with decreased blood loss and lower transfusion rates. Concerns about its impact
on renal function have prevented widespread application. This study was conducted
to review the dynamics of renal function after LCVP-assisted hepatectomy.
METHODS: A retrospective analysis of a prospective surgical database was carried
out. Estimated glomerular filtration rate (eGFR) was calculated using the
Modification of Diet in Renal Disease (MDRD) equation. The RIFLE
(risk-injury-failure-loss-end-stage) criteria were used to define postoperative
biochemical acute kidney injury (bAKI). Occurrences of clinically relevant AKI
(cAKI) were identified in the study center postoperative database. RESULTS:
During the period 2003-2012, 2116 LCVP-assisted hepatectomies were performed. The
median patient age was 61 years [interquartile range (IQR): 51-70 years] and 51%
of patients were male. The median number of resected segments was two; resections
involved from one to four segments. Median estimated blood loss was 300 ml (IQR:
200-600 ml). Rates of morbidity and 90-day mortality were 21% and 2%,
respectively. Low baseline eGFR (<90 ml/min) was seen in 84% of patients; 29% of
patients had eGFR of <30 ml/min. Postoperative bAKI was seen in 17% (n = 350) of
patients. Biochemical AKI with low eGFR was seen in 336 patients, representing
16% of the whole cohort; 13% of patients had been at risk, 2% experienced injury
and 1% experienced failure. Kidney function had normalized at discharge in 159 of
these patients. Nine patients (<1%) developed postoperative cAKI. CONCLUSIONS:
The majority of patients in the study cohort had low baseline eGFR. Biochemical
alterations in eGFR are transient in the vast majority of patients after
LCVP-assisted hepatectomy and their clinical impact is limited. The present data
suggest that clinically relevant renal dysfunction is a very uncommon event in
patients undergoing LCVP-assisted liver resection.
|Aged
[MESH]
|Blood Loss, Surgical/*prevention & control
[MESH]