Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 2, pp 686–693 | Cite as

Acute Kidney Injury After Radical Cystectomy for Bladder Cancer is Associated with Chronic Kidney Disease and Mortality

  • Taekmin Kwon
  • In Gab Jeong
  • Chunwoo Lee
  • Dalsan You
  • Bumsik Hong
  • Jun Hyuk Hong
  • Hanjong Ahn
  • Choung-Soo KimEmail author
Urologic Oncology

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 m2, 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.

Keywords

Overall Survival Chronic Kidney Disease Acute Kidney Injury Radical Cystectomy Urinary Diversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Taekmin Kwon, In Gab Jeong, Chunwoo Lee, Dalsan You, Bumsik Hong, Jun Hyuk Hong, Hanjong Ahn, and Choung-Soo Kim have no conflicts of interest or financial disclosures.

References

  1. 1.
    Carlson RW, Larsen JK, McClure J, Fitzgerald CL, Venook AP, Benson AB, et al. International adaptations of NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2014;12:643–8.PubMedGoogle Scholar
  2. 2.
    Stamatakis L, Godoy G, Lerner SP. Innovations in radical cystectomy and pelvic lymph node dissection. Semin Oncol. 2012;39:573–82.PubMedCrossRefGoogle Scholar
  3. 3.
    Takada N, Abe T, Shinohara N, Sazawa A, Maruyama S, Shinno Y, et al. Peri-operative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan. BJU Int. 2012;110:E756–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Svatek RS, Fisher MB, Matin SF, Kamat AM, Grossman HB, Nogueras-González GM, et al. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol. 2010;183:929–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.PubMedCrossRefGoogle Scholar
  6. 6.
    Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Nishikawa M, Miyake H, Yamashita M, Inoue TA, Fujisawa M. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol. 2014;19:1105–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Eisenberg MS, Thompson RH, Frank I, Kim SP, Cotter KJ, Tollefson MK, et al. Long-term renal function outcomes after radical cystectomy. J Urol. 2014;191:619–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1000 neobladders: long-term complications. J Urol. 2011;185:2207–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Teixeira C, Rosa R, Rodrigues N, Mendes I, Peixoto L, Dias S, et al. Acute kidney injury after major abdominal surgery: a retrospective cohort analysis. Crit Care Res Pract. 2014;2014:132175.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, Thottakkara P, Efron PA, Moore FA, et al. Cost and mortality associated with postoperative acute kidney injury. Ann Surg. 2015;261(6):1207–14.PubMedCrossRefGoogle Scholar
  13. 13.
    Engoren M, Habib RH, Arslanian-Engoren C, Kheterpal S, Schwann TA. The effect of acute kidney injury and discharge creatinine level on mortality following cardiac surgery. Crit Care Med. 2014;42:2069–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;53:961–73.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol. 2010;5:1734–44.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Parolari A, Pesce LL, Pacini D, Mazzanti V, Salis S, Sciacovelli C, et al. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. 2012;93:584–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Causey MW, Maykel JA, Hatch Q, Miller S, Steele SR. Identifying risk factors for renal failure and myocardial infarction following colorectal surgery. J Surg Res. 2011;170:32–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Cho A, Lee JE, Kwon GY, Huh W, Lee HM, Kim YG, et al. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transpl. 2011;26:3496–501.CrossRefGoogle Scholar
  19. 19.
    Patel HD, Ball MW, Cohen JE, Kates M, Pierorazio PM, Allaf ME. Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology. 2015;85:552–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Jeong IG, You D, Kim JW, Song C, Hong JH, Ahn H, et al. Outcomes of single lymph node positive urothelial carcinoma after radical cystectomy. J Urol. 2011;185:2085–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Jeong IG, You D, Kim J, Kim SC, Hong JH, Ahn H, et al. Factors associated with non-orthotopic urinary diversion after radical cystectomy. World J Urol. 2012;30:815–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors: a summary and commentary. Int J Surg Pathol. 2005;13:143–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Shariat SF, Svatek RS, Tilki D, Skinner E, Karakiewicz PI, Capitanio U, et al. International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int. 2010;105:1402–12.PubMedCrossRefGoogle Scholar
  25. 25.
    Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z, et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008;12:R110.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Shin S, Han Y, Park H, Chung YS, Ahn H, Kim CS, et al. Risk factors for acute kidney injury after radical nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma. J Vasc Surg. 2013;58:1021–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.Google Scholar
  28. 28.
    Kristjansson A, Wallin L, Mansson W. Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero-intestinal anastomosis. Br J Urol. 1995;76:539–45.PubMedCrossRefGoogle Scholar
  29. 29.
    Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:179–84.CrossRefGoogle Scholar
  30. 30.
    Venkataraman R, Kellum JA. Defining acute renal failure: the RIFLE criteria. J Intensive Care Med. 2007;22:187–93.CrossRefGoogle Scholar
  31. 31.
    Hoste EA, De Corte W. Clinical consequences of acute kidney injury. Contrib Nephrol. 2011;174:56–64.PubMedCrossRefGoogle Scholar
  32. 32.
    Grigoryev DN, Liu M, Hassoun HT, Cheadle C, Barnes KC, Rabb H. The local and systemic inflammatory transcriptome after acute kidney injury. J Am Soc Nephrol. 2008;19:547–58.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Taekmin Kwon
    • 1
    • 2
  • In Gab Jeong
    • 2
  • Chunwoo Lee
    • 2
  • Dalsan You
    • 2
  • Bumsik Hong
    • 2
  • Jun Hyuk Hong
    • 2
  • Hanjong Ahn
    • 2
  • Choung-Soo Kim
    • 2
    Email author
  1. 1.Department of Urology, Ulsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
  2. 2.Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

Personalised recommendations