David Romero Funes, MD, David Gutierrez Blanco, MD, Mauricio Sarmiento Cobos, MD, Emanuele Lo Menzo, MD, PhD, FACS, Rama Ganga, MD, Samuel Szomstein, MD, FACS, Raul J Rosenthal, MD, FACS. Cleveland Clinic Florida
INTRODUCTION: Obesity is an independent risk factor for kidney disease, with as much as 40% of patients undergoing bariatric surgery having some degree of kidney function impairment. In the acute postoperative setting, acute renal injury (AKI) occurs in approximately 1–5% of all hospitalized patients increasing the overall morbidity and mortality. Most studies have assessed the acute renal changes in Roux-en-Y gastric bypass, with scarce evidence regarding Laparoscopic Sleeve gastrectomy. The aim of our study is to determine the incidence of AKI following Laparoscopic sleeve gastrectomy and to describe the acute renal function changes in the first 48 hours after surgery.
METHODS: We retrospectively reviewed all patients that underwent Laparoscopic Sleeve Gastrectomy (LSG) at our institution from 2010-2015. Common demographics and comorbidities were collected as well as creatinine, preoperatively and up to 48 hours after surgery. The renal function was calculated using the CKD-EPI formula, derived and validated by Levey et al. Acute kidney injury was defined as an increase in serum creatinine by ≥0.3 mg/dL within 48 hours after surgery. All tests were two-tailed and performed at a significant level of 0.05. Statistical software R, version 3.3.1(2016-06-21) was used for all analyses.
RESULTS: Of the 1330 patients reviewed, 16.99% (n=226) patients were identified. The average age was 53.73±12.53 years with 67.3%(n=152) females and 81%(n=189) Caucasians. The incidence of Diabetes Mellitus (DM) and Hypertension (HTN) was 57.96% (n=131) and 50.44%(n=114) respectively. Chronic kidney disease Stage ≥2 (GFR <90ml/min/1.73m2) was found in 41.15% (n=93) of our population. At 48 hours follow-up, levels of creatinine decreased 0.11mg/dL and the glomerular filtration rate increased 8.4ml/min showing an improvement in renal function. Patients with preoperative CKD stage ≥2 were found to have a greater decrease in creatinine when compared to normal renal function patients (0.16±0.42 versus 0.076±0.93 P<0.015) and this is reflected as an increase in GFR (19.64±27.12 vs 5.53±8.92ml/min respectively P<0.001). The overall incidence of acute kidney injury was 1.76% (n=4), all patients having an impaired renal function at baseline and no patients in the normal renal function group developing AKI (Table 1).
CONCLUSION: The impact of Laparoscopic Sleeve Gastrectomy in renal function is evident within the first 48 hours after surgery. Patients undergoing LSG, especially patients with baseline Chronic Kidney Disease Stage ≥2 are at increased risk of developing acute kidney injury in the perioperative setting, special attention has to be made in this category of patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87062
Program Number: P634
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster