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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 723-728. doi: 10.19723/j.issn.1671-167X.2026.04.007

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Risk factors for perioperative acute kidney injury following partial nephrectomy in patients with stage 3 chronic kidney disease

Ruotao XIAO1, Zhifei XIE1,2, Peng HONG1, Bin YANG1, Lei LIU1, Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, The Second People's Hospital of Wuqing Tianjin, Tianjin 300170, China
  • Received:2026-02-25 Online:2026-08-18 Published:2026-04-30
  • Contact: Shudong ZHANG
  • Supported by:
    the Clinical Key Project of Peking University Third Hospital(BYSYZD2023050)

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Abstract:

Objective: To explore the risk factors for acute kidney injury (AKI) in patients with stage 3 chronic kidney disease (CKD) after partial nephrectomy. Methods: The clinical data of 126 stage 3 CKD patients who underwent partial nephrectomy at Peking University Third Hospital from January 2013 to December 2025 were retrospectively analyzed. Demographic characteristics, comorbidities, surgical-related indicators, and laboratory data of the patients were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate regression analyses were used to identify the independent risk factors for postoperative AKI, and the predictive cutoff value of the receiver operating characteristic (ROC) curve was determined. Results: A total of 126 stage 3 CKD patients were included. The incidence of AKI after surgery was 31.0% (39/126). Univariate analysis showed that the proportion of robotic surgery was lower in the AKI group (12.8% vs. 33.3%, P=0.018), the duration of renal artery occlusion was longer (25 min vs. 18 min, P < 0.001), and the intraoperative blood loss was greater (20 mL vs. 50 mL, P=0.028). Multivariate Logistic regression analysis confirmed that the duration of renal artery occlusion (OR=1.105, 95%CI: 1.041-1.173, P=0.001) and intraoperative blood loss (OR=1.004, 95%CI: 1.000-1.007, P=0.046) were independent risk factors for postoperative AKI. ROC curve analysis showed that the area under the curve for predicting AKI by renal artery occlusion time was 0.737, and the optimal cutoff value was 18 min. The incidence of AKI was significantly higher in the patients with renal artery occlusion time ≥ 18 min than those with < 18 min (43.2% vs. 8.8%, P < 0.001). Conclusion: The incidence of AKI after partial nephrectomy in stage 3 CKD patients is relatively high. The duration of renal artery occlusion and intra-operative blood loss are independent risk factors for postoperative AKI. Controlling the renal artery occlusion time within 18 min and minimizing intraoperative blood loss can help reduce the risk of AKI in this high-risk population after surgery.

Key words: Chronic kidney disease stage 3, Partial nephrectomy, Acute kidney injury, Risk factors, Renal artery occlusion time

CLC Number: 

  • R699.2

Table 1

Comparison of baseline data between AKI group and non-AKI group"

Variable Non-AKI group (n=87) AKI group (n=39) χ2/t/Z P
Gender, n (%) 0.220 0.652
    Male 68 (78.2) 29 (74.4)
    Female 19 (21.8) 10 (25.6)
Age/years, $\bar x \pm s$ 70.34±9.01 68.46±8.48 1.104 0.272
BMI/(kg/m2), $\bar x \pm s$ 24.06±2.82 23.72±3.98 0.542 0.589
Symptom, n (%) 0.712 0.512
    Asymptomatic 7 (8.0) 5 (12.8)
    Symptomatic 80 (92.0) 34 (87.2)
Comorbidity, n (%)
    Hypertension 61 (70.1) 29 (74.4) 0.238 0.675
    Diabetes 32 (36.8) 12 (30.8) 0.428 0.551
    Cardiovascular diseases 23 (26.4) 12 (30.8) 0.252 0.669
ASA grade, n (%) 2.048 0.359
    Ⅰ 4 (4.6) 0 (0)
    Ⅱ 63 (72.4) 31 (79.5)
    Ⅲ-Ⅳ 20 (23.0) 8 (20.5)
Surgical approach, n (%) 5.751 0.018
    Laparoscopic 58 (66.7) 34 (87.2)
    Robotic 29 (33.3) 5 (12.8)
Tumor side, n (%) 0.301 0.695
    Left 40 (46.0) 19 (51.4)
    Right 47 (54.0) 18 (48.6)
Tumor size/cm, $\bar x \pm s$ 3.11±1.97 3.47±1.13 -1.081 0.282
R.E.N.A.L. scores, n (%) 3.199 0.202
    Low risk 35 (40.2) 10 (25.6)
    Moderate risk 35 (40.2) 22 (56.4)
    High risk 17 (19.6) 7 (18.0)
Duration of the surgery/min, M (P25, P75) 136 (112, 169) 155 (120, 196) -1.887 0.059
Duration of renal artery occlusion/min, M (P25, P75) 18 (13, 25) 25 (20, 30) -4.257 < 0.001
Intraoperative bleeding/mL, M (P25, P75) 20 (10, 50) 50 (20, 200) -2.200 0.028
Complication, n (%) 5 (5.7) 4 (10.3) 0.826 0.457
Length of hospital stay/d, M (P25, P75) 6 (5, 7) 6 (4, 7) -0.379 0.705
Pathologic subtype, n (%) 0.177 0.916
    ccRCC 67 (77.0) 31 (79.5)
    Non-ccRCC 16 (18.4) 6 (15.4)
    Benign tumor 4 (4.6) 2 (5.1)
Baseline creatinine/(μmol/L), $\bar x \pm s$ 113.03±27.42 120.82±49.04 -1.139 0.257
CKD stage, n (%) 0.860 0.381
    CKD 3a 67 (77.0) 27 (69.2)
    CKD 3b 20 (23.0) 12 (30.8)
Postoperative creatinine/(μmol/L), $\bar x \pm s$ 114.33±27.42 185.56±102.11 -5.850 < 0.001
Absolute increase in creatinine/(μmol/L), $\bar x \pm s$ 1.30±27.21 64.74±84.25 -6.747 < 0.001
Creatinine elevation rate/%, $\bar x \pm s$ 0.98±15.72 57.43±92.16 -5.561 < 0.001

Table 2

Multivariate Logistic regression model analysis of AKI occurrence after partial nephrectomy"

Variable OR 95%CI Wald Pa
Surgical approach
  Laparoscopic Reference Reference Reference
  Robotic 0.302 0.086-1.067 3.458 0.063
Duration of renal artery occlusion 1.105 1.041-1.173 10.758 0.001
Intraoperative bleeding 1.004 1.000-1.007 16.788 0.046

Figure 1

ROC curve of the relationship between the duration of renal artery occlusion and the occurrence of AKI AKI, acute kidney injury; ROC, receiver operating characteristic."

1
Bex A , Abu Ghanem Y , Albiges L , et al. European association of urology guidelines on renal cell carcinoma: The 2025 update[J]. Eur Urol, 2025, 87 (6): 683- 696.

doi: 10.1016/j.eururo.2025.02.020
2
Saitta C , Afari JA , Autorino R , et al. Development of a novel score (RENSAFE) to determine probability of acute kidney injury and renal functional decline post surgery: A multicenter analysis[J]. Urol Oncol, 2023, 41 (12): 487.e15- 487.e23.

doi: 10.1016/j.urolonc.2023.09.015
3
Yang X , Zhang T , Zhou H , et al. Acute kidney injury as an independent predicting factor for stage 3 or higher chronic kidney disease after nephrectomy[J]. Urol Oncol, 2023, 41 (3): 149.e1- 149.e9.

doi: 10.1016/j.urolonc.2022.10.011
4
Kong H , Yin QL , Li M , et al. Effect of perioperative dexmedetomidine on acute kidney injury after partial nephrectomy: A single-centre, randomised, double-blind, placebo-controlled trial[J]. Br J Anaesth, 2025, 135 (5): 1212- 1222.

doi: 10.1016/j.bja.2025.08.010
5
Rajan S , Babazade R , Govindarajan SR , et al. Perioperative factors associated with acute kidney injury after partial nephrectomy[J]. Br J Anaesth, 2016, 116 (1): 70- 76.

doi: 10.1093/bja/aev416
6
Bravi CA , Vertosick E , Benfante N , et al. Impact of acute kidney injury and its duration on long-term renal function after partial nephrectomy[J]. Eur Urol, 2019, 76 (3): 398- 403.

doi: 10.1016/j.eururo.2019.04.040
7
Suer E , Akpinar C , Izol V , et al. Predicting factors of acute kidney injury after partial nephrectomy and its impact on long-term renal function: A multicentre study of the Turkish Urooncology Association[J]. Int J Clin Pract, 2021, 75 (11): e14751.
8
Obrecht F , Padevit C , Froelicher G , et al. The association of ischemia type and duration with acute kidney injury after robot-assisted partial nephrectomy[J]. Curr Oncol, 2023, 30 (11): 9634- 9646.

doi: 10.3390/curroncol30110698
9
程改平, 秦伟, 刘婧, 等. 《KDOQI慢性肾脏病营养临床实践指南2020更新版》解读[J]. 中国全科医学, 2021, 24 (11): 1325- 1332.
10
Shu F , Liu Z , Duan P , et al. A predictive model for surgical approach selection in robotic partial nephrectomy and its perioperative outcomes based on single-center retrospective data[J]. Cancer Med, 2025, 14 (3): e70625.

doi: 10.1002/cam4.70625
11
邱敏, 宗有龙, 王滨帅, 等. 腹腔镜肾部分切除术治疗中高复杂程度肾肿瘤的效果[J]. 北京大学学报(医学版), 2023, 55 (5): 833- 837.

doi: 10.19723/j.issn.1671-167X.2023.05.009
12
张中元, 唐琦, 李学松, 等. R.E.N.A.L.肾肿瘤评分系统用于保留肾单位手术的临床分析[J]. 北京大学学报(医学版), 2012, 44 (4): 539- 543.
13
付帅, 李晓宁. 肾小球滤过率计算公式研究进展: 从Cockcroft-Gault公式到FAS公式[J]. 临床肾脏病杂志, 2020, 20 (1): 73- 77.
14
郭锦洲. 改善全球肾脏病预后组织(KDIGO)临床实践指南: 急性肾损伤[J]. 肾脏病与透析肾移植杂志, 2013, 22 (1): 57- 60.
15
Bravi CA , Mari A , Larcher A , et al. Toward individualized approaches to partial nephrectomy: Assessing the correlation between ischemia time and patient health status (RECORD2 project)[J]. Eur Urol Oncol, 2021, 4 (4): 645- 650.

doi: 10.1016/j.euo.2020.05.009
16
Bonventre JV , Yang L . Cellular pathophysiology of ischemic acute kidney injury[J]. J Clin Invest, 2011, 121 (11): 4210- 4221.

doi: 10.1172/JCI45161
17
Holderied A , Kraft F , Marschner JA , et al. "Point of no return" in unilateral renal ischemia reperfusion injury in mice[J]. J Biomed Sci, 2020, 27 (1): 34.

doi: 10.1186/s12929-020-0623-9
18
Schmid M , Abd-El-Barr AER , Gandaglia G , et al. Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma[J]. Urol Oncol, 2014, 32 (8): 1259- 1266.

doi: 10.1016/j.urolonc.2014.05.002
19
Li Q , Huang Y , Zhang L , et al. Perioperative anemia predicts kidney injury after partial nephrectomy[J]. Investig Clin Urol, 2022, 63 (5): 514- 522.

doi: 10.4111/icu.20220160
20
Gumbert SD , Kork F , Jackson ML , et al. Perioperative acute kidney injury[J]. Anesthesiology, 2020, 132 (1): 180- 204.

doi: 10.1097/ALN.0000000000002968
21
Goren O , Matot I . Update on perioperative acute kidney injury[J]. Curr Opin Crit Care, 2016, 22 (4): 370- 378.
22
Karkouti K . Transfusion and risk of acute kidney injury in cardiac surgery[J]. Br J Anaesth, 2012, 109 (Suppl 1): i29- i38.
23
Thomas AA , Demirjian S , Lane BR , et al. Acute kidney injury: Novel biomarkers and potential utility for patient care in urology[J]. Urology, 2011, 77 (1): 5- 11.

doi: 10.1016/j.urology.2010.05.004
24
李强, 李铁军, 刘亮程, 等. 机器人辅助腹腔镜下阻断与不阻断肾血管肾部分切除术比较的系统评价和Meta分析[J]. 临床泌尿外科杂志, 2020, 35 (9): 709- 715.
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