Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

Vol. 44 (4): 726-733, July – August, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0283


ORIGINAL ARTICLE

Yasser Osman 1, Ahmed M. Harraz 1, Samer El-Halwagy 1, Mahmoud Laymon 1, Ahmed Mosbah 1, Hassan Abol-Enein 1, Atalla A. Shaaban 1
1 Urology and Nephrology Center, Mansoura University, Egypt

ABSTRACT

Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients.

Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses.

Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI.

Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

Keywords: Acute Kidney Injury; Cystectomy; Urinary Diversion

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