Incidence and Predictors of Acute Kidney Injury and Acute Kidney Disease After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients.

BACKGROUND AND OBJECTIVE

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.

METHODS

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.

KEY FINDINGS AND LIMITATIONS

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.

CONCLUSIONS AND CLINICAL IMPLICATIONS

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.