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Diabetes, Anuria May Predict High Postvoid Residual After Kidney Transplantation
A prospective study reports an association between diabetes mellitus and anuria with high post-void residual post-transplantation.
New research suggests diabetes mellitus (DM) and anuria are predictive factors of high post-void residual (PVR) after transplantation in patients with end-stage kidney disease.1
The findings also report a potential association between larger prostate volume in male transplant recipients and an increased likelihood of re-catheterization (RC).1
“No patients developed acute urinary retention, suggesting that proactive bladder monitoring and timely intervention may reduce this complication and potentially lower the risk of urinary leak in the early postoperative period,” wrote study investigator Jiro Kiruma, MD, PhD, a transplant surgery fellow at the Medical College of Wisconsin, and colleagues. “In addition, pre-transplant urological evaluation may be valuable for patients at risk of high PVR and RC.”1
When a transplant recipient’s age increases, lower urinary tract dysfunction (LUTD), which has been associated with benign prostatic hyperplasia (BPH) as well as DM, becomes more prevalent. In men between 60-70 years of age, 40% are affected by these conditions and increased complications. Kidney transplant recipients commonly have increased PVR, which has been observed as both a marker of LUTD and a potential risk factor for renal graft dysfunction.1,2
Through the prospective study, Kimura and colleagues aimed to develop a risk model for predicting high PVR following urinary catheter removal early in the postoperative period, and to identify risk factors for subsequent urethral recatheterization (RC) due to persistent high PVR.1
Investigators assessed patient characteristics and perioperative outcomes stratified by PVR status among participants. Anuria was defined as urine output < 100 mL per 24 hours. Once patients with high PVR were identified, investigators examined risk factors. Using the results of a multivariate analysis, they developed a risk model to predict high PVR.1
The study included 110 patients ≥ 18 years of age who underwent kidney transplantation, with 28.2% classified as high PVR (n = 31) and 71.8% as low PVR (n = 79). The mean age of the patient population was 53.0 years (Interquartile Range [IQR], 42.0–64.7), and 59.1% were men.1
Regarding comorbid conditions, 96 patients (87.3%) had hypertension, 50 (45.5%) had DM, and 22 (20.0%) had coronary artery disease (CAD). The prevalence of DM was significantly increased in the high PVR group (64.5% vs. 38.0%, P = .02), according to investigators. Furthermore, a higher proportion of patients in the high PVR group exhibited anuria before transplant (35.5%) compared to the low PVR group (16.5%) (P = .04).1
In univariate analysis, investigators discovered an association of male sex (Odds Ratio [OR], 2.53; 95% Confidence Interval [CI], 1.01–6.34; P = .047), DM (OR, 2.97; 95% CI, 1.25–7.05; P = .01), and anuria at the time of surgery (OR, 2.79; 95% CI, 1.08–7.19; P = .03) with an increased risk of high PVR. However, in multivariate analysis, only DM (OR, 3.11; 95% CI, 1.22–7.94; P = .02) and anuria at the time of surgery (OR, 3.80; 95% CI, 1.34–10.80; P = .01) remained independently predictive of high PVR.1
Overall, 14 patients (12.7%) underwent RC, with investigators reporting the most frequent indication for RC was persistent high PVR, in 10 patients (9%). Among male patients, prostate volume was significantly larger in those requiring RC (43.4 cm3) compared to those who did not (26.7 cm3, P = 0.002).1
The model demonstrated moderate accuracy in predicting high post-void residual (PVR). Based on the ROC curve, the area under the curve (AUC) was 0.72 (95% CI, 0.61–0.82), with investigators indicating the model could reliably distinguish patients with high PVR from those without.1
“These findings support a peritransplant care model that integrates pretransplant prostate size and bladder capacity assessments with early postoperative bladder scanning and targeted management in high-risk patients,” concluded investigators. “Such an approach may help reduce postoperative voiding dysfunction, preserve ureteroneocystostomy integrity, and improve graft and patient outcomes.”1
