CKD Raises Risk of Poor Urologic Surgery Outcomes

Complications and death more likely in patients with chronic kidney disease stages 3-5.
Complications and death more likely in patients with chronic kidney disease stages 3-5.

Chronic kidney disease (CKD) may independently predict poor perioperative outcomes after urologic surgery, investigators reported online ahead of print in the International Journal of Urology.

Using the National Surgical Quality Improvement Program (NSQIP) dataset, Marianne Schmid, MD, and colleagues identified 13,168 patients who underwent radical prostatectomy (65.4% of the cohort), partial nephrectomy (10.7%), radical nephrectomy (16.1%), and radical cystectomy (7.8%). Of the evaluable patients, 64.3% had reduced kidney function (estimated glomerular filtration rate [eGFR] of 89 mL/min/1.73 m2 or less).

Compared with no CKD, CKD stages 3 and 4 were independently associated with a significant 1.6 and 2.2 times increased odds of any 30-day major postoperative complication, respectively. CKD stage 3 was associated with a significant 2.1 times increased odds of requiring a blood transfusion. CKD stages 3, 4, and 5 were associated with a significant 2.6, 3.3, and 1.7 times increased odds of a prolonged length of hospital stay, respectively, and a significant 4.2, 10.1, and 17.1 times increased odds of 30-day mortality, respectively.

Prior to major urologic surgery, the authors concluded, it is crucial to assess renal function and recognize CKD for perioperative risk stratification to improve postoperative outcomes. “Better perioperative management of CKD in this population will require coordination among urologists and nephrologists with a preoperative risk assessment.”

In a discussion of the study's noteworthy findings, the researchers underscored the fact that 64.3% of the study cohort had reduced eGFR, with 14.2% of patients classified as CKD stage 3 or worse. More importantly, 17% of the initial cohort had to be excluded due to lack of available data for eGFR calculation.

“To our knowledge, this is the first estimate of the prevalence of CKD in a mixed urological oncological surgery patient cohort,” they wrote.

Dr. Schmid and her colleagues said the main strength of their study was the large sample size and its population-based nature, “with good-quality prospectively collected clinical information provided by the NSQIP dataset.” Nevertheless, the study had limitations that hinder the generalizability of the findings. For example, the NSQIP does not account for various clinical, tumor, and surgical confounders, such as preoperative hydronephrosis, radiology findings, and tumor size, stage, and grade, the researchers pointed out.

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