Impact of age, body mass index, and renal function for severe hypotension caused by oral 5-aminolevulinic acid administration in patients undergoing transurethral resection of bladder tumor

Jimpei Miyakawa, Taketo Kawai, Katsuhiro Makino, Yoshiyuki Akiyama, Yuta Yamada, Masaki Nakamura, Yusuke Sato, Daisuke Yamada, Motofumi Suzuki, Haruki Kume

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Severe hypotension is a notable adverse event caused by administration of 5-aminolevulinic acid (5-ALA) during photodynamic diagnosis-assisted transurethral resection of bladder tumor (PDD-TURBT). Hypotension can be prolonged following induction of anesthesia and may require continuous administration of a vasopressor. Here, we investigated the risk factors for severe hypotension caused by oral administration of 5-ALA. Methods: A total of 128 patients with bladder tumors who underwent PDD-TURBT using 5-ALA were included in this study. Clinicopathological data were collected retrospectively and the correlations between the incidence of severe hypotension and clinicopathological factors were analyzed. Results: Severe hypotension developed in 8 cases (6.3 %). Age ≥ 80 years, body mass index (BMI) ≥ 25 (kg/m2), and estimated glomerular filtration rate (eGFR) < 45 (mL/min/1.73 m2) were significantly correlated with severe hypotension (P = 0.003, 0.017, and 0.027, respectively). Severe hypotension developed in 1 of 89 cases (1.1 %) which have 0 or 1 risk factor, and in 3 of 31 cases (9.7 %) which have 2 risk factors, whereas it developed in 4 of 8 cases (50 %) which have all risk factors. Patients with all risk factors developed severe hypotension significantly more frequently compared with patients with 1 or fewer risk factors (P < 0.001). Conclusion: Age ≥ 80 years, BMI ≥ 25, and eGFR < 45 are risk factors for severe hypotension in PDD-TURBT using 5-ALA. The risk of developing severe hypotension is extremely high in patients who have all factors. Adjustment of the 5-ALA dose may be desirable in those patients.

Original languageEnglish
Article number102179
JournalPhotodiagnosis and Photodynamic Therapy
Volume33
DOIs
Publication statusPublished - Mar 2021
Externally publishedYes

Keywords

  • 5-Aminolevulinic acid
  • Age
  • Body mass index
  • Estimated glomerular filtration rate
  • Photodynamic diagnosis
  • Severe hypotension

ASJC Scopus subject areas

  • Biophysics
  • Oncology
  • Dermatology
  • Pharmacology (medical)

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