2025-03-25
Kidneys under pressure?
Oncology Nephrology
#ColorectalCancer #AKI #Surgery #OperativeRisk
#RiskFactors
#PostoperativeCare
Postoperative acute kidney injury (AKI) is a common complication, particularly following major surgeries such as those performed in digestive oncology. It is associated with increased mortality, prolonged hospital stays, higher readmission rates, and delayed discharge. In the context of colorectal cancer—one of the most prevalent and deadliest cancers worldwide—AKI remains an underestimated issue.
Although often transient, postoperative AKI can progress to chronic kidney disease, with long-term consequences on both quality of life and overall prognosis. The reported incidence of AKI after colorectal surgery varies widely in the literature, ranging from 1% to over 20%, depending on the definitions used and the populations studied. This variability reflects a lack of consensus on specific risk factors, making it difficult to implement effective prevention strategies.
In this context, a meta-analysis was conducted to identify and assess the most frequently associated risk factors for postoperative AKI in patients undergoing surgery for colorectal cancer. The goal is to improve preoperative detection of at-risk patients, optimize perioperative management, and reduce postoperative morbidity related to this renal complication.
Twenty-three studies involving a total of 167,904 patients who underwent surgery for colorectal cancer were included. To be eligible, studies had to clearly define AKI using KDIGO or AKIN criteria and provide usable data in the form of odds ratios (OR). The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale to ensure reliable results.
This research highlights several significant KI risk factors,postoperative A grouped into three major categories. From a demographic perspective, male sex, advanced age, and a body mass index (BMI) ≥ 25 kg/m² were associated with increased risk. Medically, a history of hypertension, diabetes, chronic kidney disease, or preoperative hypoalbuminemia also raised the risk. Regarding surgical characteristics, emergency surgery, open surgical approach, prolonged operative time, an ASA score ≥ 3, and intraoperative blood transfusion were all significantly linked to a higher incidence of AKI.
In contrast, preoperative anemia and elevated baseline creatinine levels did not appear to be significantly associated with postoperative AKI. Similarly, open surgery and blood transfusion were shown to clearly increase the risk of AKI after colorectal surgery. These findings demonstrate that AKI risk is multifactorial, involving both modifiable and non-modifiable factors that must be considered to improve the management of colorectal cancer surgery patients.
Acute kidney injury after colorectal surgery is a common and serious complication that can worsen a patient’s condition and slow recovery. The key challenge is to quickly identify patients at risk, in order to adjust care and prevent AKI—especially in individuals already weakened by cancer and comorbidities. This study was initiated to identify and quantify the main risk factors for AKI following colorectal cancer surgery, with the aim of guiding clinical practices toward more targeted and preventive management.
The results confirm that AKI risk is multifactorial, influenced by the patient's profile, nutritional and renal status, and procedure-related factors. These findings provide several intervention points to help reduce the risk. Prospective, multicenter, and better-standardized studies are needed to refine these conclusions. Ultimately, improved risk stratification would allow for the integration of renal evaluation into preoperative pathways, enabling targeted AKI prevention—an essential step toward enhancing the quality of care in digestive oncology.
Postoperative acute kidney injury (AKI) is a common complication, particularly following major surgeries such as those performed in digestive oncology. It is associated with increased mortality, prolonged hospital stays, higher readmission rates, and delayed discharge. In the context of colorectal cancer—one of the most prevalent and deadliest cancers worldwide—AKI remains an underestimated issue.
Although often transient, postoperative AKI can progress to chronic kidney disease, with long-term consequences on both quality of life and overall prognosis. The reported incidence of AKI after colorectal surgery varies widely in the literature, ranging from 1% to over 20%, depending on the definitions used and the populations studied. This variability reflects a lack of consensus on specific risk factors, making it difficult to implement effective prevention strategies.
In this context, a meta-analysis was conducted to identify and assess the most frequently associated risk factors for postoperative AKI in patients undergoing surgery for colorectal cancer. The goal is to improve preoperative detection of at-risk patients, optimize perioperative management, and reduce postoperative morbidity related to this renal complication.
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Which patients are most at risk for aki after surgery?
Twenty-three studies involving a total of 167,904 patients who underwent surgery for colorectal cancer were included. To be eligible, studies had to clearly define AKI using KDIGO or AKIN criteria and provide usable data in the form of odds ratios (OR). The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale to ensure reliable results.
This research highlights several significant KI risk factors,postoperative A grouped into three major categories. From a demographic perspective, male sex, advanced age, and a body mass index (BMI) ≥ 25 kg/m² were associated with increased risk. Medically, a history of hypertension, diabetes, chronic kidney disease, or preoperative hypoalbuminemia also raised the risk. Regarding surgical characteristics, emergency surgery, open surgical approach, prolonged operative time, an ASA score ≥ 3, and intraoperative blood transfusion were all significantly linked to a higher incidence of AKI.
In contrast, preoperative anemia and elevated baseline creatinine levels did not appear to be significantly associated with postoperative AKI. Similarly, open surgery and blood transfusion were shown to clearly increase the risk of AKI after colorectal surgery. These findings demonstrate that AKI risk is multifactorial, involving both modifiable and non-modifiable factors that must be considered to improve the management of colorectal cancer surgery patients.
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Preventing AKI: mission possible?
Acute kidney injury after colorectal surgery is a common and serious complication that can worsen a patient’s condition and slow recovery. The key challenge is to quickly identify patients at risk, in order to adjust care and prevent AKI—especially in individuals already weakened by cancer and comorbidities. This study was initiated to identify and quantify the main risk factors for AKI following colorectal cancer surgery, with the aim of guiding clinical practices toward more targeted and preventive management.
The results confirm that AKI risk is multifactorial, influenced by the patient's profile, nutritional and renal status, and procedure-related factors. These findings provide several intervention points to help reduce the risk. Prospective, multicenter, and better-standardized studies are needed to refine these conclusions. Ultimately, improved risk stratification would allow for the integration of renal evaluation into preoperative pathways, enabling targeted AKI prevention—an essential step toward enhancing the quality of care in digestive oncology.
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