ACUTE KIDNEY INJURY AFTER RENAL SURGERY IN PRE-OPERATIVE ADVANCED CKD PATIENTS: YOU SURE YOU KNOW EVERYTHING?

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Abstract Title

First Name *

Francesco

Last Name *

Trevisani

Co-author 1

Francesco Trevisani trevisani.francesco1@gmail.com San Raffaele Scientific Institute Urology Milano

Co-author 2

Giuseppe Rosiello rosiello.giuseppe@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 3

Umberto Capitanio capitanio.umberto@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 4

Alessandro Larcher larcher.alessando@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 5

Arianna Bettiga bettiga.arianna@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 6

Matteo Floris matt.floris@gmail.com Brotzu Hospital Nephrology Cagliari

Co-author 7

Andrea Salonia salonia.andrea@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 8

Francesco Montorsi montorsi.francesco@hsr.it San Raffaele Scientific Institute Urology Milano

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Despite major advance in surgical techniques in the last decade, acute kidney injury (AKI) is still a major postoperative complication in renal surgery, both in radical (RN) than in partial nephrectomy (PN). One of the most intriguing arguments is to understand if patients affected by pre-operative advanced CKD (stage III-IV-V) require, immediately after surgery, a nephrological intervention to avoid a severe grade of AKI and eventually ESRD. Therefore, aim of our study was to compare the AKI incidence and ESRD with RRT after RN and PN in a selected consecutive cohort of patients with eGFR < 60 ml/min 1.73 (CKD stage III and IV)

Methods

A consecutive cohort-study of 614 patients who underwent radical (RN) or partial nephrectomy (PN) due to the presence of a kidney mass suspected of malignancy from 2000-2022 in a tertiary care Institution. All clinical and laboratory variables were collected. Serum creatinine (s-Cr) values were reported before surgery (t0), at 48 hours after surgery and at dismissal to detect renal function fluctuations and the subsequent risk of AKI. GFR was estimated at each time point using CKD-EPI 2012 formula. Comparisons between groups were performed using Kruskal-Wallis ranks sum test for numerical variables and Pearson’s Chi square test for categorical variables. Logistic regression was used to identify variables ODDS Ratio for AKI onset after surgery.

Results

Descriptive analysis is reported in table 1. AKI onset showed a significantly different distribution (p<0.001) between the RN and PN. However also the PN, a conservative surgery, revealed a high incidence of AKI (59,6%). Regarding the ESRD requiring acute RRT, the incidence was surprisingly very low in both groups ( PN: 2,2 %; RN : 3,5%). In the multivariate analysis, the AKI incidence was related to BMI, pre-operative eGFR,,Tumor size and surgery (table 2)

Conclusions

Our study highlights that in advanced CKD stages both PN and RN display a high incidence of AKI (> 60%). Surprisingly, the incidence of RRT after surgery was very low ( < 3%) even for RN patients affected by CKD stage IV, suggesting a pre-operative already established compensatory hyperfiltration mechanism of the non-cancerous kidney

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