Incidence and risk factors for acute kidney injury after radical cystectomy

Abstract

Abbreviations & Acronyms AKI = acute kidney injury AKIN = Acute Kidney Injury Network BMI = body mass index CI = confidence interval CVD = cardiovascular disease DM = diabetes mellitus eGFR = estimated glomerular filtration rate HT = hypertension IHD = ischemic heart disease KDIGO = Kidney Disease: Improving Global Outcomes NAC = neoadjuvant chemotherapy NSAID = non-steroidal antiinflammatory drugs OR = odds ratio POD = postoperative day RC = radical cystectomy RIFLE = Risk, Injury, Failure, Loss, End-Stage Renal Disease RRT = renal replacement therapy sCr = serum creatinine UD = urinary diversion UTI = urinary tract infection Objectives: To clarify the incidence, risk factors and clinical impact of acute kidney injury after radical cystectomy. Methods: A total of 210 patients who underwent radical cystectomy at Sapporo Medical University Hospital, Sapporo, Japan, from January 2006 through December 2012 were evaluated. The incidence of acute kidney injury was evaluated over the first 7 days postoperatively, during which time a ureteral catheter was inserted. Risk factors for postoperative acute kidney injury and its impacts on short-term clinical outcomes were evaluated. Results: Finally, 145 patients were eligible for this study. Postoperative acute kidney injury was observed in 48 patients (33.1%), with stages 1, 2, and 3 found in 33 (22.7%), 14 (9.6%) and 1 (0.7%), respectively. All patients with stage 1 and 2 acute kidney injury recovered by postoperative day 7, except for one with stage 1. Hypertension (P < 0.001), preoperative estimated glomerular filtration rate <60 mL/min/1.73 m 2 (P = 0.04) and neoadjuvant chemotherapy (P = 0.03) were independent risk factors for postoperative acute kidney injury. Furthermore, postoperative acute kidney injury was an independent risk factor for acute kidney injury after ureteral stent removal, but not of persistent elevated serum creatinine, prolonged hospital stay or the new onset of cardiovascular disorders during the hospital stay. Conclusions: The incidence of acute kidney injury after radical cystectomy is relatively high, although most cases are low grade and can be resolved. We should be aware of the risk for postoperative acute kidney injury, especially in patients who have comorbid hypertension, impaired renal function and received naoadjuvant chemotherapy.

Re: Incidence and risk factors for acute kidney injury after radical cystectomy

“…We thank Jin et al 1 for their comment on our article. As they commented, the incidence of acute kidney injury (AKI) would increase when using serum creatinine adjusted by the fluid balance, which was proposed by Moore et al 2 However, we can see that the incidence of surgery-associated death, need for renal replacement therapy and length of stay…”

“…In a retrospective study by Ikehata et al assessing the incidence, risk factors and impact on short-term outcomes of postoperative acute kidney injury (AKI) in patients undergoing radical cystectomy, they showed that hypertension, estimated glomerular filtration rate <60 mL/min/1.73 m 2 and neoadjuvant chemotherapy were independent risk factors for postoperative AKI. 1 However, postoperative AKI was not associated with prolonged hospital stay. Other than the limitations described by the authors in the Discussion, we noted that several issues of this study were not well addressed.…”

Response to Re: Incidence and risk factors for acute kidney injury after radical cystectomy

“…As they commented, the incidence of acute kidney injury (AKI) would increase when using serum creatinine adjusted by the fluid balance, which was proposed by Moore et al . However, we can see that the incidence of surgery‐associated death, need for renal replacement therapy and length of stay in the intensive care unit after radical cystectomy (RC) were all significantly less than after cardiac surgery . Therefore, the diagnosis of AKI by using adjusted serum creatinine would be unlikely to affect short‐term postoperative clinical outcomes in the current study.…”

Association Between Postoperative 3^rd Month Renal Function After Radical Cystectomy and Preoperative Factors, Oncologic Outcomes, and Complications

“…However, numerous studies have demonstrated the relationship between renal function and patients' preoperative characteristics, comorbidities, and presence of hydronephrosis (2,4,5). Risk factors for early postoperative acute renal dysfunction have also been identified (6). However, there are no definitive data regarding the effects of postoperative renal function on post-RC complications (6) and oncologic outcomes.…”

“…Risk factors for early postoperative acute renal dysfunction have also been identified (6). However, there are no definitive data regarding the effects of postoperative renal function on post-RC complications (6) and oncologic outcomes. The aim of this study was to investigate the association between postoperative renal function and preoperative factors, post-RC oncologic outcomes, and complications.…”