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Radical cystectomy (RC) represents the first line surgical treatment for muscle-invasive bladder cancer (MIBC), a worldwide increasing malignant neoplasm. However, RC represents the most complex and invasive surgery in urology, characterized by significant morbidity and mortality. Among RC patients, the incidence of post-operative acute kidney injury (AKI) and Acute kidney disease (AKD) is still not clear, due to the paucity of data. Aim of the study was to evaluate the incidence of AKI and AKD after RC.
A consecutive cohort of 839 patients who underwent RC for MIBC in a tertiary institution between 2010 and 2022 was collected. All clinical variables, comorbidities, surgeries techniques and oncological regimen were reported pre and after surgery. Serum creatinine and eGFR using CKD-EPI formula were collected at baseline pre-operative and in the acute setting at 24h, 48, 72h, 6 days for the AKI onset, and after 9,12,15,18,21,24,27,30,45, 60, 75, 90 days for the AKD establishment. Fisher's exact test; Wilcoxon rank sum test; Pearson's Chi-squared test were used for the statistical analysis.
General characteristics of patients included in the study are summarized in Table 1. Surprisingly, a very high rate of both AKI (30%) and AKD (50%) was reported in the total cohort of patients, with an augmented incidence in the elder pts, low pre-operative eGFR, pre-existing CKD, BMI > 24, robotic surgery and hypertensive pts in the multivariate analysis (table 2). Moreover, stage II and III of both AKI and AKD affected a non-negligible percentage of patients, requiring advanced nephrological medical treatments and prolonged hospitalization.
AKI and AKD are very common but hidden side effects in the RC for MIBC. Therefore, a personalized nephrological counseling both in the pre and post -surgery asset is necessary to reduce morbidity and mortality.