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Kidney Week

Abstract: TH-PO077

Outcomes of Renal Function After Urinary Diversion for AKI among Patients with Obstructive Uropathy Secondary to Malignancy Admitted in a Tertiary Hospital

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

  • Comonsad, Renee glorien Espiga, Philippine Society of Nephrology, Cagayan de Oro City, Philippines
Background

Acute kidney injury secondary to malignant obstructive uropathy is associated with poor prognosis. Urinary diversion with percutaneous nephrostomy or DJ ureteral stenting have been used to manage this potentially life-threatening condition. The study aimed to compare the renal function outcomes of patients with malignant obstructive uropathy and to determine the predictors of poor renal function after urinary diversion.

Methods

A retrospective cohort study was conducted to collect data on 112 patients admitted in a tertiary training hospital in Metro Manila from January 2015 to January 2018. EpiInfo 6 was used to compute for the sample size. Both descriptive and inferential statistics were used to describe the baseline patient characteristics and to compare the pre- and post-urinary diversion renal function outcomes.

Results

The mean age of patients was 51.52 ± 11 years with majority being females, 96/112 (85.71%). The mean number of days from admission to urinary diversion was 10.31 ± 13.08 days while the mean hospital days from admission to discharge was 24.45 ± 16.38 days. In paired t-test, there was a significant improvement in the post-urinary diversion renal function parameters including BUN, creatinine, GFR, sodium, potassium, and calcium (all p-value < 0.05) but not albumin (p-value 0.0785). Recovery of renal function (i.e. creatinine reduction of more than 25% from baseline) was achieved by 79/103 (76.7%) of patients. On multiple linear regression, for every one year increase in age, there was a corresponding 0.81 ml/min/1.73 m2 reduction in GFR (95% CI -1.35 - -0.27, p-value 0.004) while for every one day delay in urinary diversion from admission, there was a corresponding 1.09 ml/min/1.73 m2 reduction in GFR (95% CI -1.86 - -0.31, p-value 0.007). On multiple logistic regression, the significant predictors of poor GFR (<60 ml/min/1.73 m2) post-urinary diversion were age (OR 1.11, 95% CI 1.03-1.19, p-value 0.006) and number of days delay from admission to urinary diversion (OR 1.24, 95% CI 1.02-1.51, p-value 0.034).

Conclusion

Prompt urinary diversion significantly improved renal function outcomes. Urinary diversion should not be delayed especially in the older patient population.