Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial.

Wu Mei Wen, Fiona; Burkhard, Fiona C.; Turri, Filippo; Furrer, Marc; Löffel, Lukas; Thalmann, George; Wüthrich, Patrick Yves (2017). Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Urologic oncology - seminars and original investigations, 35(10), 602.e11-602.e17. Elsevier 10.1016/j.urolonc.2017.05.024

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OBJECTIVE To determine whether a restrictive perioperative fluid management in the context of an enhanced recovery after surgery program for radical cystectomy and urinary diversion affects renal function, as fluid restriction and the use of vasopressors have been linked to impaired tissue perfusion, potentially resulting in renal dysfunction. METHODS We followed 166 patients initially included in a randomized clinical trial and equally allocated to receive a continuous norepinephrine administration combined with 1ml/kg/h initially, and after cystectomy 3ml/kg/h crystalloid infusion (intervention group, n = 83), or a standard crystalloid infusion of 6ml/kg/h throughout surgery (control group, n = 83). All patients followed our institutional enhanced recovery after surgery program. We prospectively assessed renal function (plasma creatinine values and estimated glomerular filtration rate Chronic Kidney Disease Epidemiology Collaboration equation) postoperatively. Decreased renal function was defined as a decrease in glomerular filtration rate is greater than 20% compared to preoperative values. RESULTS There was no significant difference in renal function between the groups postoperatively at any time point after discharge: diabetes mellitus (HR = 2.81 [95% CI: 1.48-5.36]; P = 0.002), preoperative estimated glomerular filtration rate (HR = 1.02 [95% CI: 1.00-1.03]; P = 0.007), and age (OR = 1.03 [95% CI: 11.00-1.06]; P = 0.038) were negative predictors for renal deterioration. CONCLUSION Postoperative renal function evolution was similar in patients receiving restrictive hydration with norepinephrine administration when compared to liberal hydration intraoperatively, suggesting that there is no influence of fluid management and administration of vasopressors on mid-term renal function.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Wu Mei Wen, Fiona; Burkhard, Fiona C.; Furrer, Marc; Löffel, Lukas; Thalmann, George and Wüthrich, Patrick Yves

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1078-1439

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

10 Oct 2017 09:46

Last Modified:

23 Jan 2018 12:13

Publisher DOI:

10.1016/j.urolonc.2017.05.024

PubMed ID:

28648412

Uncontrolled Keywords:

Cystectomy Hydration Norepinephrine Renal function

BORIS DOI:

10.7892/boris.101698

URI:

https://boris.unibe.ch/id/eprint/101698

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