ACUTE KIDNEY INJURY AFTER UROLOGIC SURGERIES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Advanced Practice Providers1 Apr 2018PD13-09 ACUTE KIDNEY INJURY AFTER UROLOGIC SURGERIES Shahab Bozorgmehri, Scott Gilbert, Robert L. Cook, Rebecca Beyth, Tezcan Ozrazgat-Baslanti, Azra Bihorac, and Muna Canales Shahab BozorgmehriShahab Bozorgmehri More articles by this author , Scott GilbertScott Gilbert More articles by this author , Robert L. CookRobert L. Cook More articles by this author , Rebecca BeythRebecca Beyth More articles by this author , Tezcan Ozrazgat-BaslantiTezcan Ozrazgat-Baslanti More articles by this author , Azra BihoracAzra Bihorac More articles by this author , and Muna CanalesMuna Canales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is common after urologic procedures but predictive factors for AKI and recovery of AKI are not well known. METHODS This is a retrospective study of 1,557 adult patients who underwent common urologic procedures and were hospitalized for 48 hours or more in a tertiary health care center from 2000 to 2010. We categorized patients according to their procedure type and defined AKI using consensus RIFLE (R-risk, I-injury, F-failure, L-loss of kidney function, E-end-stage renal disease) classification. Renal outcomes were categorized as complete, partial or no renal recovery according to consensus. We used logistic regression models to identify predictive factors for occurrence of AKI as well as incomplete recovery following AKI episode. Predictive performance of the fitted models was assessed using ROC curve analysis. RESULTS Mean(SD) age was 60(15) years, 67% were males, and 82% were Caucasian. Among 1,557 patients, 601(39%) developed AKI. The occurrence of AKI by procedure type was: 53% for radical cystectomy, 46% for nephroureterectomy/total nephrectomy, 38% for endoscopic/other type of urologic procedures, 25% for partial nephrectomy, and 19% for radical prostatectomy. Among 601 patients who developed AKI, the AKI-RIFLE distribution was 67%, 20%, and 13% for RIFLE class-R, I, and F, respectively. Type of urologic surgery, lower baseline estimated glomerular filtration rate (eGFR), weekend admission, congestive heart failure, cancer, urinary tract infections (UTIs), urinary obstruction/hydronephrosis, and use of vasopressors or vancomycin were independently associated with higher likelihood of AKI (AUC: 0.69; 95%Cl: 0.66-0.71). Among patients with AKI, 23% patients had partial or no renal recovery after AKI. Type of urologic surgery, more severe AKI, no UTIs, older age and higher baseline eGFR were independently associated with higher odds of incomplete renal recovery (AUC: 0.82; 95%Cl: 0.78-0.86). CONCLUSIONS AKI was common following urologic procedures and varied according to the type of urologic procedure. Nearly a quarter of patients with AKI did not achieve complete renal recovery. We identified several key risk factors for AKI and incomplete recovery. Our findings will inform future studies to investigate intervention strategies targeting modifiable risk factors to prevent AKI in patients undergoing urologic surgeries. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e302 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Shahab Bozorgmehri More articles by this author Scott Gilbert More articles by this author Robert L. Cook More articles by this author Rebecca Beyth More articles by this author Tezcan Ozrazgat-Baslanti More articles by this author Azra Bihorac More articles by this author Muna Canales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...