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

Abstract

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/m² (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 m² 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.