Zaurito Paolo, Calado Alexandre, Quarta Leonardo, Longoni Mattia, Scilipoti Pietro, Santangelo Alfonso, Viti Alessandro, Cosenza Andrea, Scuderi Simone, Barletta Francesco, Stabile Armando, Dimonte Alessio, Denti Marco, Barbieri Simone, Esposito Antonio, Montorsi Francesco, Trevisani Francesco, Gandaglia Giorgio, Briganti Alberto
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Eur Urol Oncol. 2025 Jul 10. doi: 10.1016/j.euo.2025.06.011.
Acute kidney injury (AKI) and acute kidney disease (AKD) are neglected complications of robot-assisted radical prostatectomy (RARP) that may lead to chronic kidney disease (CKD). We investigated their incidence and predictors in prostate cancer (PCa) patients undergoing RARP.
Overall, 3551 consecutive patients who underwent RARP at a high-volume tertiary center were evaluated. Electronic health records were used to define AKI (within 7 d from surgery) and AKD (between 8 and 90 d after surgery) according to creatinine values. A Least Absolute Shrinkage and Selection Operator (LASSO) regression selected the final set of variables for predicting each outcome (AKI and AKD). A locally estimated scatterplot smoothing regression explored the interaction between baseline estimated glomerular filtration rate (eGFR) and the model-based probability of developing AKI or AKD.
Overall, 844 (23.8%) vs. 2073 (58.4%) vs. 634 (17.8%) patients had low- vs. intermediate- vs. high-risk PCa. The baseline eGFR was 86.8 ml/min/m (interquartile range: 74.6-96.3). Overall, 131 (3.7%) and 134 (18.5%) patients experienced AKI and AKD after RARP, respectively, whereas 16 (2.2%) patients developed CKD stage ≥3 after surgery. Age at surgery (p = 0.042) and baseline eGFR (p = 0.002) were significant predictors of AKI and AKD, respectively. Patients with an eGFR of <80-85 ml/min/1.73 m at baseline were at a higher risk of developing AKI/AKD.
The incidence of AKI after RARP approaches 4%, and one out of five patients is at risk of AKD. Preoperative eGFR emerged as a strong predictor of AKD. Proper identification of patients at risk may lead to optimized intra- and postoperative management.
急性肾损伤（AKI）和急性肾病（AKD）是机器人辅助根治性前列腺切除术（RARP）被忽视的并发症，可能导致慢性肾病（CKD）。我们调查了接受RARP的前列腺癌（PCa）患者中它们的发生率及预测因素。
总体上，对一家大型三级中心连续接受RARP的3551例患者进行了评估。根据肌酐值，利用电子健康记录来定义AKI（术后7天内）和AKD（术后8至90天）。最小绝对收缩和选择算子（LASSO）回归选择用于预测每个结局（AKI和AKD）的最终变量集。局部加权散点平滑回归探索了基线估计肾小球滤过率（eGFR）与基于模型发生AKI或AKD的概率之间的相互作用。
总体上，844例（23.8%）、2073例（58.4%）和634例（17.8%）患者分别患有低、中、高风险PCa。基线eGFR为86.8 ml/min/m²（四分位间距：74.6 - 96.3）。总体上，分别有131例（3.7%）和134例（18.5%）患者在RARP术后发生AKI和AKD，而16例（2.2%）患者术后发展为CKD 3期及以上。手术年龄（p = 0.042）和基线eGFR（p = 0.002）分别是AKI和AKD的显著预测因素。基线时eGFR < 80 - 85 ml/min/1.73m²的患者发生AKI/AKD的风险更高。
RARP术后AKI的发生率接近4%，五分之一的患者有发生AKD的风险。术前eGFR是AKD的有力预测因素。正确识别有风险的患者可能会优化术中和术后管理。
