Acute kidney disease after radical cystectomy for bladder cancer: a new onco-nephrological view

To assess the incidence of acute kidney injury (AKI) and acute kidney disease (AKD) following radical cystectomy (RC) in patients with muscle-invasive bladder cancer (BCa).

A consecutive cohort of 840 patients undergoing RC for muscle-invasive BCa at a tertiary institution (2010-2022) was analysed. Clinical variables, comorbidities, surgical techniques and oncological regimens were recorded pre- and post-surgery. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at baseline, at 24, 48 and 72 h, and 6 days post-surgery for AKI, and at multiple intervals up to 60 days for AKD. Chronic kidney disease (CKD) stages G1 G2 and ≥G3 were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. A multivariable logistic regression model was used to predict postoperative AKI or AKD risk.

Of the patients included in the study, 33% developed AKI and 54% developed AKD. Independent predictors included advanced age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), chronic hypertension (OR 1.43, 95% CI 1.03-2.00) and Charlson Comorbidity Index ≥2 (OR 1.59, 95% CI 1.09-2.33). Surgical factors, including use of a robot-assisted approach (OR 2.28, 95% CI 1.50-3.49) and ileal neobladder diversion (OR 1.84, 95% CI 1.05-3.24) were significant, possibly due to the associated prolonged operating times and metabolic challenges. Baseline renal function (CKD ≥G3, OR 2.17, 95% CI 1.28-3.68) and lower preoperative eGFR strongly correlated with AKD risk; a baseline eGFR below 20 mL/min was associated with an AKD risk ≥80%.

Our results showed that AKI and AKD are frequent complications of RC for muscle-invasive BCa. Personalised nephrological counselling pre- and post-surgery is essential to minimise morbidity and mortality.