Study to analyse factors influencing need for haemodialysis prior to deobstructive procedures for obstructive uropathy
Abhijit Konnur, Sishir Gang, Arvind Ganpule, Nitiraj SheteBackground:
Patients with obstructive uropathy frequently require haemodialysis prior to undergoing deobstructive surgical procedures. However, there are limited data on the necessity of preoperative dialysis and its impact on clinical outcomes. This study aims to evaluate the role of dialysis before deobstructive procedures and its influence on postoperative outcomes.
Materials and Methods:
This retrospective observational study included all patients who underwent deobstruction procedures between January 2017 and September 2022 and had renal failure (serum creatinine > 4 mg/dL). A comparator group included patients undergoing deobstruction procedures with either serum creatinine > 3 times baseline, > 4 mg/dL, or anuric for more than 12 hours, but who did not require dialysis. The primary outcome assessed was renal recovery, and secondary outcomes included (1) incidence of acute left ventricular failure, (2) presence of hyperkalaemia (serum potassium > 6 mEq/L) and metabolic acidosis (serum bicarbonate < 18 mEq/L) postprocedure, (3) type of anaesthesia used (general, spinal, or local), (4) intraoperative bleeding > 500 mL or need for packed cell volume (PCV) transfusion within 1 week postprocedure, and (5) duration of hospitalisation following the procedure.
Conclusions:
The need for dialysis prior to deobstruction procedures was primarily determined by the presence of chronic kidney disease, hyperkalaemia, and uremic symptoms. Patients who did not undergo dialysis had a higher risk of perioperative bleeding. Local anaesthesia was more commonly used in patients who required dialysis. Importantly, preoperative dialysis did not significantly influence renal recovery following the procedure.
Level of evidence:
Not applicable