High aortic calcification burden is a novel risk factor for acute kidney injury in patients undergoing radical cystectomy for muscle-invasive bladder cancer, investigators revealed at the 38th Congress of the European Association of Urology (EAU23) in Milan, Italy.

Among 616 patients who underwent radical cystectomy from September 1998 to April 2022, acute kidney injury developed in 335 patients (54%), Naoki Fujita, MD, of Hirosaki University Graduate School of Medicine in Hirosaki, Japan, reported on behalf of his team.

The investigators measured each patient’s calcification burden using the aortic calcification index (ACI). According to a receiver operating characteristic curve, the threshold for acute kidney injury development was an ACI of 25% or more, Dr Fujita reported. Among the 616 patients, 248 patients had an ACI of 25% or more and 368 patients had an ACI less than 25%.

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To calculate the ACI for each patient, 10 preoperative computed tomography scans were taken at 10 mm intervals along the aorta segment located above the bifurcation of the common iliac arteries. Each cross-sectional slice of the aorta was divided into 12 sectors similar to a pizza pie. Investigators tallied the percentage of the 12 sectors that contained calcification. The ACI was the average percentage of calcified sectors across the 10 scans.

Acute kidney injury developed in a significantly higher proportion of the high ACI group compared with low ACI group: 64% vs 48%, Dr Fujita reported. In multivariable analysis, an ACI of 25% or more was significantly associated with 1.5-fold increased odds of acute kidney injury. In addition, each 1-point increase in ECOG performance status and each 1 kg/m2 increase in body mass index were significantly associated with 1.8- and 1.1-fold increased odds of acute kidney injury, respectively. Hypertension increased the odds of acute kidney injury by 1.5-fold. Greater kidney function was significantly associated with decreased odds of acute kidney injury.

Aortic calcification may lead to arterial degradation that increases the risk for acute kidney injury, Dr Fujita’s team suggested.

At the American Society of Clinical Oncology’s 2023 Genitourinary Cancers Symposium, Dr Fujita reported on a related study demonstrating that acute kidney injury during neoadjuvant chemotherapy is associated with worse oncologic outcomes in patients with muscle-invasive bladder cancer.


Fujita N, Momota M, Horiguchi H, et al. High aortic calcification burden is a risk factor for acute kidney injury in patients who undergoing radical cystectomy: A multi-institutional retrospective cohort study. Presented at: EAU23 Congress, Milan, Italy, March 10-13. Abstract A0148.