An evaluation of perioperative acute kidney injury during laparoscopic sleeve gastrectomy using the acute kidney injury network classification

Objective: Perioperative acute kidney injury (AKI) is associated with increased morbidity and mortality, and we investigated risk factors of perioperative AKI. In addition, we measured the incidence of perioperative AKI and intraoperative hypotension in patients with advanced obesity. Methods: Fifty consecutive patients who underwent laparoscopic sleeve gastrectomy were identified using hospital records. Perioperative AKI was diagnosed and classified using serum creatinine (sCr)-based AKIN criteria. Results: Twelve patients (24%) developed perioperative AKI. Patients developed perioperative AKI had more elevated preoperative sCr (p = 0.035) and lower intraoperative urine output (p = 0.006). Male sex (OR 13.59, p = 0.004), BMI > 40 kg/m² (OR 6.18, p = 0.019) and intraoperative sustained hypotension (mean arterial pressure < 55 mmHg, duration > 10 minutes (OR 5.33, p = 0.021)) were risk factors that affected the incidence of perioperative AKI. In addition, the duration of hypotension (mean arterial pressure < 55 mmHg) was positively correlated with BMI (R² = 0.36). Conclusion: Patient undergoing sleeve gastrectomy developed perioperative AKI at a high rate. High preoperative sCr, male sex, BMI > 40 kg/m² and intraoperative sustained hypotension are associated with perioperative AKI in morbidly obese patients. It is important to maintain blood pressure and avoid the use of drugs that may impair renal function in these patients.