Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy

Purpose Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is understood about this possibility among kidney surgical populations.

This study aimed to elucidate the incidence of AKD after partial nephrectomy and risk factors that promote the AKI to AKD transition.

Methods From January 2010 to January 2020, this study retrospectively collected a dataset of consecutive patients with renal masses undergoing partial nephrectomy in 4 urological centers.

Cox proportional regression analyses were adopted to identify risk factors that promoted the AKI to AKD transition.

To avoid overfitting, the results were then verified by logistic least absolute shrinkage and selection operator (LASSO) regression.

A nomogram was then constructed and validated for AKI to AKD transition prediction.

Results AKI and AKD occurred in 228 (21.4%) and 42 (3.9%) patients among a total of 1062 patients, respectively.

In patients with AKI, multivariable Cox regression analysis and LASSO regression identified that age (HR 1.078, 1.029–1.112, p < 0.001), baseline eGFR (HR 1.015, 1.001–1.030, p < 0.001), RENAL score (HR1.612, 1.067–2.437, p = 0.023), ischemia time > 30 min (HR 7.284, 2.210–23.999, p = 0.001), and intraoperative blood loss > 300ml (HR 8.641, 2.751–27.171, p < 0.001) were risk factors for AKD transition.

These five risk factors were then integrated into a nomogram.

The nomogram showed excellent discrimination, calibration, and clinical net benefit ability.

Conclusion Around 3.9% patients following partial nephrectomy would transit from AKI to AKD.

Intraoperative blood loss and ischemia time need to be diminished to avoid on-going functional decline.

Our nomogram can accurately predict the transition from AKI to AKD.