Introduction: AUA guidelines recommend immediate intervention for hemodynamically unstable renal trauma patients. Selective angioembolization is favored due to potential nephron sparing when compared to surgery, yet the impact on renal function is not well established. We previously reported that angioembolization was associated with renal failure requiring hemodialysis (HD). We now present updated data with additional patients and associated transfusion data. We hypothesized that angioembolization for high-grade renal injuries does not increase the need for HD when corrected for the degree of hemorrhage. Methods: 742 patients with high-grade renal trauma, defined as American Association for the Surgery of Trauma Grade (AAST) III-V injuries, from 2005 through 2022 were identified from our institutional trauma registry. Univariate and multivariate analyses were performed to identify associations with hypotension on arrival, ASST, age, injury severity score (ISS), presence of bilateral renal injuries, urinary extravasation, perinephric fluid collection, transfusion status and renal embolization with the need for HD. Results: 574 (77.4%) patients had AAST III injuries, 91 (12.3%) had AAST IV and 77 (10.4%) had AAST V. Twenty-one (2.8%) of 742 patients had renal failure requiring HD during their trauma admission. Of those 21 patients, 4 (19.0%) underwent an angioembolization. Variables associated with need for HD were hypotension on admission (p=0.003), concomitant adrenal injury (p < 0.001), concomitant pancreatic injury (p=0.047), renal vascular injury (p < 0.0001), AAST injury grade (p < 0.0001), age (p=0.003), ISS (p < 0.0001), units of blood transfused in the first 24 hours (p=0.008) and angioembolization (p < 0.001). ISS (OR 1.06, 95% CI 1.03-1.10) and angioembolization (OR 7.77, 95% CI 2.00-25.3) were found to be independently associated with renal failure requiring HD in a multivariate model, while blood transfused during the first 24 hours post-injury was not (OR 1.03, 95% CI 0.98-1.10). Conclusions: Current practice in high-grade renal trauma favors selective embolization as first-line therapy for renal hemorrhage in unstable patients. Our data suggest that overall injury severity and selective embolization are independently associated with need for HD following high-grade renal trauma. While angioembolization is the current best strategy to preserve renal function, further research is required to understand its impact on renal functional outcomes long-term. SOURCE OF Funding: None
