MP60-02 PRETREATMENT NEUTROPHIL-TO-LYMPHOCYTE RATIO IS AN INDEPENDENT PREDICTOR OF ADVANCED PATHOLOGIC STAGE AND CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH UROTHELIAL CARCINOMA UNDERGOING RADICAL CYSTECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: The term acute kidney injury (AKI) has been proposed to encompass the spectrum of the syndrome from minor changes in renal function to the need for renal replacement therapy (RRT). AKI is seen after general surgery and is associated with morbidity and mortality. Although several studies have addressed the incidence and risk factors for AKI after cardiac and noncardiac surgery, little is known about AKI after urologic surgery. Radical cystectomy (RC) is one of the most invasive surgeries of the urogenital organs. The purpose of this study was to clarify the incidence and risk factors for AKI after RC based on the international Kidney Disease: Improving Global Outcomes (KDIGO) criteria. METHODS: A total of 210 patients underwent RC and urinary diversion (UD) in our institution from January 2006 through December 2012. Finally, evaluation of AKI associated with surgery was feasible for 145 patients, who were then enrolled in this study. Intraoperatively, a ureteral stent was inserted immediately after division of the ureter to avoid obstructive uropathy while minimizing the intraperitoneal urine exposure. The stent was removed 7 days after surgery. Postoperative AKI was assessed within 7 days after surgery according to the KDIGO definition. We evaluated their sex, age, body mass index, comorbidity, neoadjuvant chemotherapy (NAC), preoperative estimated glomerular filtration rate (eGFR), type of UD, operative time, amount of blood loss and postoperative NSAID use to determine the risk factors for postoperative AKI. The chi-square test and logistic regression analysis were used for univariate and multivariate analyses, respectively. RESULTS: Postoperative AKI was observed in 48 patients (33.1%), with stages 1, 2 and 3 in 33 (22.7%), 14 (9.6%) and 1 (0.7%), respectively. One patient (0.7%) required RRT. AKI had no influence on the postoperative course in any patient except the one who had stage 3 AKI and died of vascular complications. In univariate analysis, comorbid hypertension (P < 0.001) and preoperative eGFR < 60 ml/min/m2 (P 1⁄4 0.004) were significantly associated with postoperative AKI. Multivariate analysis revealed that hypertension (P < 0.001) and NAC (P 1⁄4 0.03) were independent risk factors for postoperative AKI. CONCLUSIONS: The incidence of AKI after RC is relatively high, althoughmost cases are low grade and can bemanaged conservatively. We should be aware of the risk for postoperative AKI, especially in patients who have comorbid hypertension and receive NAC.