静脉注射5%白蛋白与肾部分切除术后急性肾损伤的关系。回顾性研究

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-14 DOI:10.1016/j.jclinane.2025.111873

Juan Jose Guerra-Londoño MD , Sergio M. Moreno-Lopez Ph.D. , Satvik Gundre , Azzi Jehanzeb , Ryan Wong , Nicolas Cortes-Mejia MD , Diana Bejarano-Ramirez , Cassius K.B. Mensah MD , Juan P. Cata MD

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引用次数: 0

摘要

各种研究表明，部分肾切除术后急性肾损伤（AKI）是一种常见的术后并发症，可影响近一半的患者。在目前的研究中，我们调查了术中给药5%白蛋白与部分肾切除术后AKI的关系。方法本研究为单中心回顾性研究，纳入行部分肾切除术的成年患者。根据KIDGO的定义，主要终点是术后72小时内的AKI。次要终点是发生AKI的时间、再手术时间、AKI严重程度和住院时间。我们使用基于倾向评分的最近邻方法来平衡患者的基线特征。结果共纳入1688例患者，其中5%白蛋白组809例，对照组879例。配对后，729例患者接受5%白蛋白治疗，对照组674例。5%白蛋白组急性肾损伤（AKI）发生率（32.78%）明显高于对照组（25.51%）。多变量分析显示，接受5%白蛋白治疗与发生AKI的风险增加32%相关。此外，分析表明这种关联是剂量依赖性的。结论：本研究提示术中给予5%白蛋白可能不是部分肾切除术后AKI的危险因素。鉴于这些结果与以往研究之间的差异，需要未来的前瞻性随机对照试验来证实我们的发现。

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Association between intravenous 5 % albumin administration and acute kidney injury after partial nephrectomy. A retrospective study

Background

Acute kidney injury (AKI) after partial nephrectomy is a frequent postoperative complication that can affect nearly half of patients, according to various studies. In the current study, we investigated the association of intraoperative administration of 5 % albumin, compared with crystalloids alone, with AKI after partial nephrectomy.

Methods

This single-center retrospective study included adult patients undergoing partial nephrectomy. The primary endpoint was AKI within 72 h after surgery using the KIDGO definition. Secondary endpoints were time-to-AKI, reoperations, AKI severity and length of hospital stay. We used propensity score-based nearest-neighbor methods balance the patient baseline characteristics.

Results

A total of 1688 patients were included in the analysis, with 809 receiving 5 % albumin and 879 in the control group. After matching, 729 patients received 5 % albumin, while 674 were controls. The incidence of acute kidney injury (AKI) was significantly higher in the 5 % albumin group (32.78 %) compared to the control group (25.51 %). Multivariate analysis revealed that receiving 5 % albumin was associated with a 32 % increased risk of developing AKI. Furthermore, the analysis indicated that this association was dose-dependent.

Conclusion

Our study suggests that intraoperative administration of 5 % albumin may not be a risk factor for AKI after partial nephrectomy. Given the discrepancy between these results and previous studies, a future prospective randomized controlled trial is needed to confirm our findings.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.