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Kidney Week

Abstract: PO2177

Acute Kidney Disease After Microinvasive Radical Cystectomy for Bladder Cancer Is Associated with CKD

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Ge, Shengnan, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Tang, Ying, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Chen, Junzhe, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Fu, Sha, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Huang, Qiuyan, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Yu, Wenjuan, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
  • Xu, Anping, Sun Yat-Sen University Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
Background

Acute kidney disease (AKD) proposed in 2012 by KDIGO is getting more and more attention for its vital role in acute kidney injury (AKI) to chronic kidney disease (CKD) transition. However, no study has explored the incidence, risk factors of AKD and its impact on new-onset CKD after microinvasive radical cystectomy(RC).

Methods

The medical records of 308 patients at our hospital between January 2014 and May 2019 were reviewed. We excluded 29 patients from the study due to missing SCr preoperatively or postoperatively. AKD was diagnosed as a ≥35% decrease in eGFR or >50% increase in SCr between 7-90 days after surgery.AKI alone was defined by the 2012 KDIGO classification but failed to meet AKD criteria after 7 days. No kidney disease (NKD) was defined if patients didn't meet either criteria. Logistic regression model was used to explore risk factors of AKD,while its significance for CKD was assessed using Kaplan-Meier analysis and Cox model.

Results

We evaluated 279 bladder cancer patients, including 168 for Robotic-assisted Laparoscopic RC and 111 for Laparoscopic RC. The incidence of AKD was 14.7% whereas AKI alone was 13.6%. Risk factors for AKD included chemotherapy (odds ratio [OR]=3.245,P=0.024), robotic RC(OR=2.437,P=0.029)and operation time (OR=1.005,P=0.012). Of 150 patients without CKD history, CKD developed in 62.5% of patients with AKD,33.3% with AKI alone and 30.6% with NKD during the 30 months follow up (p=0.013).K-M analysis showed AKD patients had the highest CKD incidence(Fig.1). Cox model also identified AKD (HR=2.224,p=0.012) but not AKI alone ,was independent risk factor predicting CKD, along with age.

Conclusion

The incidence of AKD was higher than AKI alone after microinvasive RC and resulted in higher risk of new-onset CKD compared with No-AKD. This persistent or repetitive injury is significantly associated with CKD.Hence, interventions for AKD are needed to improve outcomes.

Figure 1. Kaplan–Meier analysis