Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy

Abstract

< 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. RESULTSOf the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. CONCLUSIONSPatients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. KEYWORDSchronic renal insufficiency, metabolic acidosis, proteinuria, nephron-sparing surgery, radical nephrectomy, RCC Study Type -Prognosis (case series) Level of Evidence 4

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

“…RN was also identified as an independent risk factor (HR 3.08, p<0.001) for the development of an elevated serum creatinine level (≥2.0 mg/dL).Other independent risk factors for decline in renal function determined by this study included a pre-operative diagnosis of DM, HTN, or CKD. 140 These and other studies lay the foundation for developing the association between PN and improved renal function. The current study, however, offers several important advantages and insights when comparing its results to the previous literature.…”

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

“…In recent studies conducted among patients who underwent a radical procedure, lower preoperative eGFR, older age, and history of comorbidities were associated with lower postoperative eGFR (8,9), whereas older age, history of comorbidities, and tobacco use have been independently associated with the development of CKD following nephrectomy (10)(11)(12)(13). Notably, not all patients develop CKD, and indeed some patients experience improved renal function after surgery (5).…”

The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

“…63 After surgical resection, the prevalence of CKD rose from 10%-24% to 16%-52%. [58][59][60] Postoperative risk of new diagnosis or progression of CKD was also related to these same risk factors 64,65 but also included obesity, 65,66 decreased GFR, larger tumor size 60,63 and corresponding renal volume reduction, 67 hypoalbuminemia, 59 and postoperative AKI. 68 Diabetes mellitus and preexisting CKD likewise increased risk for progression to ESRD (4.05% for RCC versus 0.68% for control with hazard ratio [HR], 5.63; 95% confidence interval [95% CI], 4.37 to 7.24) over a 10-year follow-up period in an incident cohort (RCC, n=2940; control, n=23,520).…”