Incidence and Risk Factors of Acute Kidney Injury after Radical Cystectomy: Importance of Preoperative Serum Uric Acid Level

Abstract

Background: Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. While radical cystectomy associates significantly with an increased risk of serious complications, including AKI, risk factors of AKI after radical cystectomy has not been reported. This study was performed to determine the incidence and independent predictors of AKI after radical cystectomy.Methods: All consecutive patients who underwent radical cystectomy in 2001-2013 in a single tertiary-care center were identified. Their demographics, laboratory values, and intraoperative data were recorded. Postoperative AKI was defined and staged according to the Acute Kidney Injury Network criteria on the basis of postoperative changes in creatinine levels. Independent predictors of AKI were identified by univariate and multivariate logistic regression analyses.Results: Of the 238 patients who met the eligibility criteria, 91 (38.2%) developed AKI. Univariate logistic regression analyses showed that male gender, high serum uric acid level, and long operation time associated with the development of AKI. On multivariate logistic regression analysis, preoperative serum uric acid concentration (odds ratio [OR] = 1.251; 95% confidence interval [CI] = 1.048-1.493; P = 0.013) and operation time (OR = 1.005; 95% CI = 1.002-1.008; P = 0.003) remained as independent predictors of AKI after radical cystectomy.Conclusions: AKI after radical cystectomy was a relatively common complication. Its independent risk factors were high preoperative serum uric acid concentration and long operation time. These observations can help to prevent AKI after radical cystectomy.

Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review

“…Preoperative UA level was also a strong predictor of postoperative AKI. In patients undergoing radical cystectomy, preoperative SUA was an independent predictor of postoperative AKI [122]. In a retrospective study of more than two thousand patients who underwent coronary bypass surgery, preoperative SUA was a strong predictor for the development of postoperative AKI [123].…”

Comparison of postoperative acute kidney injury between ileal conduit and neobladder urinary diversions after radical cystectomy

“…Our previous study showed that long surgical time was an independent risk factor for AKI after radical cystectomy. [ 8 ] Second, there was no difference in blood transfusion requirement, which is another well-known risk factor of AKI after surgery, between the 2 groups. A recent retrospective study showed that intraoperative blood transfusion was associated with AKI after major abdominal surgery.…”

“…As previously described, [ 8 ] anesthetic techniques for radical cystectomy were performed as per our institutional standards. General anesthesia was induced using thiopental or propofol, fentanyl, and muscle relaxants (vecuronium or rocuronium) and was maintained using volatile anesthetics (isoflurane, sevoflurane, or desflurane), a 50% O 2 /air mixture, fentanyl, and muscle relaxants (vecuronium or rocuronium).…”

“…[ 5 , 6 ] Moreover, AKI after radical cystectomy is also known to be associated with a higher incidence of chronic kidney disease and mortality. [ 7 ] Recently, the overall incidence of AKI after radical cystectomy was reported to be 31% to 38%; [ 7 , 8 ] however, little is known regarding the incidences of AKI for the different types of urinary diversion. Therefore, we compared the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy.…”

Risk factors and outcomes of myocardial injury after non-cardiac surgery in high-risk patients who underwent radical cystectomy

“…[ 12 , 13 ] General anesthesia was performed according to our institutional standards for radical cystectomy. [ 14 – 16 ] Anesthesia was induced with propofol or thiopental sodium and rocuronium and was maintained with sevoflurane. The concentration of sevoflurane was set to maintain a bispectral index of 40 to 60.…”