Taekmin Kwon1,2, In Gab Jeong2, Chunwoo Lee2, Dalsan You2, Bumsik Hong2, Jun Hyuk Hong2, Hanjong Ahn2, Choung-Soo Kim3. 1. Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. 2. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. cskim@amc.seoul.kr.
Abstract
PURPOSE: The aim of this study was to investigate the prevalence of acute kidney injury (AKI) after radical cystectomy, and evaluate its impact on chronic kidney disease (CKD) and mortality. METHODS: The medical records of 866 patients who underwent radical cystectomy for bladder cancer were reviewed. AKI was assessed within 7 days after surgery according to the Acute Kidney Injury Network criteria. The prevalence of AKI after surgery was examined, and the significance of AKI for CKD and mortality was analyzed. RESULTS: Of 866 patients, 269 (31.1 %) developed AKI in the first week after surgery. Of these, 231 (85.9 %) were at stage 1, 32 (11.9 %) at stage 2, and 6 (2.2 %) at stage 3. Of 722 patients with a preoperative Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m(2), CKD developed in 23.0 % (118/513) of patients in the non-AKI group and 32.5 % (68/209) of patients in the AKI group. Independent factors predicting new-onset CKD were a preoperative eGFR (p < 0.001), age (p = 0.011), urinary tract complication (p < 0.001) and AKI (p = 0.015). In all, 297 patients died (191 in the non-AKI group and 106 in the AKI group). AKI also correlated significantly with overall survival (p = 0.001). CONCLUSIONS: AKI is not only commonly encountered after radical cystectomy but is also associated with higher CKD rates and mortality. There is a critical need for strategies to increase the identification of patients at risk of postoperative AKI, and to improve the management of patients, with an aim toward preventing AKI and improving the treatment of AKI once it occurs.
PURPOSE: The aim of this study was to investigate the prevalence of acute kidney injury (AKI) after radical cystectomy, and evaluate its impact on chronic kidney disease (CKD) and mortality. METHODS: The medical records of 866 patients who underwent radical cystectomy for bladder cancer were reviewed. AKI was assessed within 7 days after surgery according to the Acute Kidney Injury Network criteria. The prevalence of AKI after surgery was examined, and the significance of AKI for CKD and mortality was analyzed. RESULTS: Of 866 patients, 269 (31.1 %) developed AKI in the first week after surgery. Of these, 231 (85.9 %) were at stage 1, 32 (11.9 %) at stage 2, and 6 (2.2 %) at stage 3. Of 722 patients with a preoperative Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m(2), CKD developed in 23.0 % (118/513) of patients in the non-AKI group and 32.5 % (68/209) of patients in the AKI group. Independent factors predicting new-onset CKD were a preoperative eGFR (p < 0.001), age (p = 0.011), urinary tract complication (p < 0.001) and AKI (p = 0.015). In all, 297 patients died (191 in the non-AKI group and 106 in the AKI group). AKI also correlated significantly with overall survival (p = 0.001). CONCLUSIONS: AKI is not only commonly encountered after radical cystectomy but is also associated with higher CKD rates and mortality. There is a critical need for strategies to increase the identification of patients at risk of postoperative AKI, and to improve the management of patients, with an aim toward preventing AKI and improving the treatment of AKI once it occurs.
Authors: Abhijat Kitchlu; Eric McArthur; Eitan Amir; Christopher M Booth; Rinku Sutradhar; Habeeb Majeed; Danielle M Nash; Samuel A Silver; Amit X Garg; Christopher T Chan; S Joseph Kim; Ron Wald Journal: J Natl Cancer Inst Date: 2019-07-01 Impact factor: 13.506
Authors: Eunjeong Kang; Minsu Park; Peong Gang Park; Namyong Park; Younglee Jung; U Kang; Hee Gyung Kang; Dong Ki Kim; Kook-Hwan Oh; Kwon Wook Joo; Yon Su Kim; Hyung-Jin Yoon; Hajeong Lee Journal: Cancer Med Date: 2019-04-09 Impact factor: 4.452