Risk factors for acute kidney injury following radical cystectomy: a systematic review and meta-analysis.

BACKGROUND

The factors contributing to acute kidney injury (AKI) after radical cystectomy (RC) remain uncertain. This study aimed to determine the risk factors for AKI following RC and guide clinicians in implementing effective interventions for high-risk groups.

METHODS

Three English databases were searched for relevant articles published until November 2024. The odds ratio (OR), 95% confidence interval (CI), and P value were determined for each study using univariate or multivariate analysis. Random effects models were applied for high heterogeneity ( I2  ≥ 50% or P < 0.05) instead of fixed effects models. Moreover, descriptive analysis was performed when meta-analysis was unfeasible. We investigated heterogeneity by performing subgroup and sensitivity analyses. A funnel plot was used to test for publication bias when the number of included studies was >10.

RESULTS

Nine studies were included in the meta-analysis. The meta-analysis revealed that older age (OR = 1.02, 95% CI = [1.00, 1.03], P = 0.008), operative route (robot versus open, OR = 2.41, 95% CI = [1.35, 4.31], P = 0.003), and nonsteroidal anti-inflammatory drug use (OR = 1.50, 95% CI = [1.01, 2.23], P = 0.05) were risk factors for postoperative AKI. Female gender (OR = 0.55, 95% CI = [0.35, 0.88], P = 0.01) was identified as a protective factor against postoperative AKI. Body mass index (OR = 1.02, 95% CI = [1.00, 1.04], P = 0.06), diabetes (OR = 1.00, 95% CI = [0.65, 1.53], P = 0.98), hypertension (OR = 1.76, 95% CI = [0.79, 3.93], P = 0.17), smoking (OR = 1.01, 95% CI = [0.74, 1.39], P = 0.94), cardiovascular disease (OR = 1.37, 95% CI = [0.70, 2.68], P = 0.35), estimated glomerular filtration rate (OR = 1.00, 95% CI = [0.98, 1.02], P = 0.89), neoadjuvant chemotherapy (OR = 1.23, 95% CI = [0.69, 2.20], P = 0.49), operation time (OR = 1.00, 95% CI = [0.99, 1.01], P = 0.87), intraoperative bleeding volume (OR = 1.00, 95% CI = [1.00, 1.00], P = 0.73), blood transfusion (OR = 1.46, 95% CI = [0.79, 2.72], P = 0.23), enhanced recovery after surgery program (OR = 1.35, 95% CI = [0.65, 2.78], P = 0.42), and urinary diversion (OR = 1.03, 95% CI = [0.45, 2.39], P = 0.94) were not associated with increased risk of AKI after RC.

CONCLUSION

Obvious risk factors for AKI include one patient-related risk factor, such as older age, and two therapy-related risk factors, such as robot surgery and the use of nonsteroidal anti-inflammatory drugs. Moreover, obvious protective factors for AKI include one patient-related factor, such as the female gender. However, these findings should be approached carefully, as most of these risk factors exhibited minimal effect sizes. Nonetheless, they could aid clinicians in identifying high-risk patients for better prognosis.