Intraoperative Renal Desaturation and Postoperative Acute Kidney Injury

Study Overview
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Brief Summary
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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
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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.

Official Title
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Intraoperative Renal Desaturation and Postoperative Acute Kidney Injury in Elderly Patients Undergoing Liver Resection: a Prospective Cohort Study

Conditions
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Postoperative Acute Kidney Injury

Intervention / Treatment
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* Device: Near-infrared spectroscopy


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| elderly patients following liver resection<br>elderly patients (aged ≥60 years) scheduled for any type of liver resection due to benign or malignant hepatobiliary diseases | Device: Near-infrared spectroscopy<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative acute kidney injury | Postoperative acute kidney injury is defined according to the KDIGO criterion | Postoperative 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Death before and 30 days after discharge | Collection of clinical data in the medical record and follow-up update through telephone | 30 days after discharge | 
| Length of hospital stay | Collection of clinical data in the medical record | Postoperative 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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liver resection, elderly, renal oxygen saturation, near-infrared spectroscopy