Predicting acute kidney injury after radical cystectomy for muscle-invasive bladder cancer

Radical cystectomy (RC) with urinary diversion remains the gold standard for the treatment of muscle invasive tumors. RC is a major surgery associated with a high morbidity rate. Postoperative acute kidney injury (AKI) is associated with severe morbidity and mortality. In this study we attempted to identify risk factors for postoperative AKI in patients undergoing RC.

A multicenter retrospective analysis was conducted among patients treated with radical cystectomy for muscle-invasive bladder cancer between 2015 and 2024. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO), within 90 days of surgery, with the occurrence of 1 of the 3 items: (1) increase in serum creatinine by ≥ 26.5 µmol/L within 48 h; (2) increase in serum creatinine ≥ 1.5-time baseline, which is known or presumed to have occurred within the prior seven days; (3) urine volume < 0.5 ml/kg/h during 6 h, KDIGO score were also recorded. Data were compared between two groups of patients: occurrence of AKI within the first 30 days of the post-operative period (AKI group) or no AKI during this period (no AKI group).

We included 520 patients. The incidence of postoperative AKI was 40.38% (n = 210). Patients with AKI were active smoker (p = 0.03), significantly less often anemic (p = 0.01), had a higher BMI (p = 0.002), preoperative anemia (p = 0.01). Duration of surgery was longer in AKI patients (p < 0.001). AKI patients were more likely to need vasoactive agents (p = 0.04). Independent factors associated with AKI were intraoperative blood loss (OR = 4.8 [95%CI: 3.06-6.43]; p = 0.01), duration of surgery (OR = 3.36 [95%CI: 2.9-11.19]; p = 0.0014); Preoperative anemia (OR = 2.69 [95%CI: 1.06-5.2]; p < 0.001); use of vasoactive agents (OR = 6.36, [95%CI: 6.01-36.87]; p < 0.001). Postoperative AKI was not associated with 2-year mortality (p = 0.71).

A significant number of patients experienced AKI after RC. Recognizing pre- and perioperative risk factors can identify patients where close surveillance and early intervention may help minimize renal function decline following RC.