PD12-04 UPDATED EVALUATION OF THE IMPACT OF ANGIOEMBOLIZATION ON THE NEED FOR DIALYSIS FOLLOWING HIGH-GRADE RENAL TRAUMA

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You have accessJournal of UrologyCME1 Apr 2023PD12-04 UPDATED EVALUATION OF THE IMPACT OF ANGIOEMBOLIZATION ON THE NEED FOR DIALYSIS FOLLOWING HIGH-GRADE RENAL TRAUMA George Koch, Leah Chisholm, Rohan Bhalla, Abimbola Ayangbesan, Craig Hill, Jennifer Huang, William Walton, and Niels Johnsen George KochGeorge Koch More articles by this author , Leah ChisholmLeah Chisholm More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Craig HillCraig Hill More articles by this author , Jennifer HuangJennifer Huang More articles by this author , William WaltonWilliam Walton More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AUA guidelines recommend immediate intervention for hemodynamically unstable renal trauma patients. Selective angioembolization is favored due to potential nephron sparing when compared to surgery, yet the impact on renal function is not well established. We previously reported that angioembolization was associated with renal failure requiring hemodialysis (HD). We now present updated data with additional patients and associated transfusion data. We hypothesized that angioembolization for high-grade renal injuries does not increase the need for HD when corrected for the degree of hemorrhage. METHODS: 742 patients with high-grade renal trauma, defined as American Association for the Surgery of Trauma Grade (AAST) III-V injuries, from 2005 through 2022 were identified from our institutional trauma registry. Univariate and multivariate analyses were performed to identify associations with hypotension on arrival, ASST, age, injury severity score (ISS), presence of bilateral renal injuries, urinary extravasation, perinephric fluid collection, transfusion status and renal embolization with the need for HD. RESULTS: 574 (77.4%) patients had AAST III injuries, 91 (12.3%) had AAST IV and 77 (10.4%) had AAST V. Twenty-one (2.8%) of 742 patients had renal failure requiring HD during their trauma admission. Of those 21 patients, 4 (19.0%) underwent an angioembolization. Variables associated with need for HD were hypotension on admission (p=0.003), concomitant adrenal injury (p<0.001), concomitant pancreatic injury (p=0.047), renal vascular injury (p<0.0001), AAST injury grade (p<0.0001), age (p=0.003), ISS (p<0.0001), units of blood transfused in the first 24 hours (p=0.008) and angioembolization (p<0.001). ISS (OR 1.06, 95% CI 1.03-1.10) and angioembolization (OR 7.77, 95% CI 2.00-25.3) were found to be independently associated with renal failure requiring HD in a multivariate model, while blood transfused during the first 24 hours post-injury was not (OR 1.03, 95% CI 0.98-1.10). CONCLUSIONS: Current practice in high-grade renal trauma favors selective embolization as first-line therapy for renal hemorrhage in unstable patients. Our data suggest that overall injury severity and selective embolization are independently associated with need for HD following high-grade renal trauma. While angioembolization is the current best strategy to preserve renal function, further research is required to understand its impact on renal functional outcomes long-term. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e401 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Leah Chisholm More articles by this author Rohan Bhalla More articles by this author Abimbola Ayangbesan More articles by this author Craig Hill More articles by this author Jennifer Huang More articles by this author William Walton More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...