Acute kidney injury to predict cardiovascular outcomes following radical cystectomy: A multicenter retrospective study.

725 Background: Acute kidney injury (AKI) is a common complication in patients undergoing radical cystectomy (RC). Although AKI has been associated with adverse cardiovascular outcomes in various clinical settings, its impact on cardiovascular outcomes in patients undergoing RC remains unclear. Methods: This multicenter retrospective cohort study included 919 patients with muscle-invasive bladder cancer who underwent RC. AKI was defined according to the KDIGO criteria. Patients were categorized into four groups based on AKI stage. Major adverse cardiovascular events (MACE) were defined as a composite of myocardial infarction, stroke, and cardiovascular death. Multivariable Cox proportional hazards regression analysis was performed to assess the impact of perioperative AKI on MACE-free survival. Results: The median age of the cohort was 70 years, and the median follow-up period was 54 months. Among the 919 patients, 366 (40%), 93 (10%), and 34 (3.7%) developed stage 1, 2, and 3 AKI, respectively. MACE-free survival was significantly shorter in the AKI group compared to the non-AKI group ( P = 0.012). Patients with stage 1 AKI did not show a statistically significant difference in MACE-free survival compared to those with stage 0 AKI ( P = 0.063). However, patients with stage 3 AKI had significantly shorter MACE-free survival than those with stage 0 and stage 2 AKI ( P < 0.001 for both comparisons). After adjusting for confounding variables, stage 3 AKI remained independently and significantly associated with shorter MACE-free survival. Conclusions: Severe perioperative AKI is independently associated with worse long-term cardiovascular outcomes in patients undergoing RC, regardless of preoperative renal function. Multivariable analysis for MACE-free survival. Factor P value Hazard ratio 95% CI Age Continuous 0.185 1.019 0.991–1.049 Body mass index Continuous 0.741 0.989 0.927–1.056 Hypertension Presence 0.011 1.886 1.156–3.078 Dyslipidemia Presence 0.708 1.100 0.668–1.813 Diabetes mellitus Presence 0.370 1.257 0.762–2.072 History of CVD Presence 0.004 1.964 1.240–3.110 Preoperative eGFR Continuous 0.002 0.980 0.969–0.992 AKI Stage 0 Reference - Stage 1 0.306 1.275 0.801–2.031 Stage 2 0.227 1.550 0.761–3.155 Stage 3 0.049 2.430 1.005–5.877