Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Int J Urol. 2022 Jul;29(7):713-723. doi: 10.1111/iju.14879. Epub 2022 Apr 1.
To determine whether early acute kidney injury affects mid-term renal function, to identify risk factors for impaired mid-term renal function, and to highlight the evolution of plasma creatinine and estimated glomerular filtration rate in the first 12 months after cystectomy and urinary diversion.
We conducted a single-center retrospective observational cohort study from 2000 to 2019. We included 900 consecutive patients undergoing cystectomy and urinary diversion. Patients with incomplete data and preoperative hemodialysis were excluded. Early acute kidney injury was defined as an increase in plasma creatinine of >50% or >26.5 μmol/L within 24 h after surgery. Multiple linear regression analysis was performed to model the association between risk factors and change in plasma creatinine and estimated glomerular filtration rate at 12 months.
Early acute kidney injury was diagnosed in 183/900 patients (20.3%) and was associated with significant mid-term plasma creatinine increase compared to preoperative value (+10.0 μmol/L [95% confidence interval -1.5, 25.0] vs +4.0 μmol/L [-7.0, 13.0]; P < 0.001). Similarly, a significant estimated glomerular filtration rate change was found (-11.2 mL/min [95% confidence interval -19.8, 0.6] vs -4.9 mL/min [-15.6, 5.3]; P < 0.001). In the linear regression model, early acute kidney injury increased creatinine at 12 months by 9.8% (estimated glomerular filtration rate: decrease by 6.2 mL/min), male sex by 12.0%. Limitations include retrospective analysis from prospectively assessed data.
Early acute kidney injury resulted in elevated plasma creatinine and decreased estimated glomerular filtration rate values 12 months postoperatively, albeit the clinical relevance remains questionable.
确定早期急性肾损伤是否会影响中期肾功能，确定中期肾功能受损的危险因素，并强调胱切除术和尿流改道后 12 个月内血浆肌酐和估算肾小球滤过率的演变。
我们进行了一项 2000 年至 2019 年的单中心回顾性观察队列研究。共纳入 900 例连续接受胱切除术和尿流改道的患者。排除数据不完整和术前血液透析的患者。早期急性肾损伤定义为术后 24 小时内血浆肌酐升高>50%或>26.5μmol/L。采用多元线性回归分析模型，分析危险因素与术后 12 个月血浆肌酐和估算肾小球滤过率变化的关系。
900 例患者中 183 例（20.3%）诊断为早期急性肾损伤，与术前值相比，中期血浆肌酐显著升高（+10.0μmol/L[95%置信区间-1.5，25.0]比+4.0μmol/L[-7.0，13.0]；P<0.001）。同样，估算肾小球滤过率也有显著变化（-11.2mL/min[95%置信区间-19.8，0.6]比-4.9mL/min[-15.6，5.3]；P<0.001）。在线性回归模型中，早期急性肾损伤使 12 个月时肌酐增加 9.8%（估算肾小球滤过率：下降 6.2mL/min），男性增加 12.0%。局限性包括从前瞻性评估数据进行的回顾性分析。
早期急性肾损伤导致术后 12 个月时血浆肌酐升高和估算肾小球滤过率降低，尽管其临床相关性仍存在疑问。
