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

Abstract

Background and objectives Partial nephrectomy or radical nephrectomy is the standard of care for patients with kidney neoplasms, but surgery may result in loss of renal function. We sought to identify patient characteristics associated with renal functional recovery following radical nephrectomy.Design, setting, participants, & measurements We performed a retrospective study among 572 patients with kidney neoplasms who underwent RN between 2006 and 2013. The primary endpoint was recovery of postoperative eGFR to the preoperative level. We plotted the trajectory of each patient's eGFR from their first postoperative visit up to 3 years after surgery. Cumulative incidence and competing risks regression estimated associations between patient and clinical characteristics and eGFR recovery, stratified by preoperative eGFR.Results Median age was 61.5 years; 68% of patients were male, and 89% were white. Overall, eGFR increased over time following an initial postoperative decrease. Median postoperative follow-up among survivors was 10.8 (minimum, 0.03; maximum, 36.0) months; during follow-up, 263 patients achieved eGFR recovery. Median time to eGFR recovery was 25.3 months. Two-year cumulative incidence of eGFR recovery was 49% overall and 44% and 58% among those with preoperative eGFR$60 and ,60 ml/min per 1.73 m 2 , respectively (P,0.001). On multivariable analysis, younger age at surgery and female sex were significantly associated with a higher chance of eGFR recovery among patients with preoperative eGFR,60 ml/min per 1.73 m 2 . Among patients with preoperative eGFR$60 ml/min per 1.73 m 2 , hypertension was significantly associated with a lower chance of eGFR recovery, whereas increased tumor size was significantly associated with a higher chance of eGFR recovery.Conclusions Overall, almost half of the patients in this study recovered to their preoperative eGFR by 2 years following surgery. Distributions of preoperative risk factors differed by preoperative eGFR, leading to distinct factors that were significantly associated with chance of eGFR recovery.

Partial nephrectomy is not associated with an overall survival advantage over radical nephrectomy in elderly patients with stage Ib‐II renal masses: An analysis of the national cancer data base

“…It is noteworthy that we observed attenuated OS trends favoring PN similar to those previously reported by Lane and colleagues. 22 These findings are bolstered by evidence demonstrating that nearly one-half of patients who undergo RN recover their estimated glomerular filtration rate by 2 years after surgery 26 and are corroborated by reports supporting preserved long-term renal function after donor nephrectomy. 27 Taken together, these data may help explain why the observed OS benefit for PN relative to RN is smaller than previously believed for some patients.…”

Outcome Measures Used to Report Kidney Function in Studies Investigating Surgical Management of Kidney Tumours: A Systematic Review

“…Regression to the mean also needs to be considered when interpreting these results (especially if only a single preoperative measure is taken), where patients with high preoperative kidney function are more likely to experience a greater postsurgical decline, whereas patients with low preoperative kidney function would be expected to demonstrate the opposite, on average. This may have partially contributed to the findings reported by Choi et al [28] and Zabor et al [29], where patients with low baseline kidney function were more likely to experience smaller declines in eGFR and return to baseline eGFR, respectively, than patients with high baseline kidney function.…”

The adjuvant treatment of kidney cancer: a multidisciplinary outlook

“…Around 30% of these patients will ultimately relapse so will require active oncological treatment with either VEGFR-TKI or immune checkpoint inhibitors. As concomitant CKD increases the risk of use of suboptimal dose-intensities and treatment-related toxicities, especially when VEGFR-TKI are used 76,77 , this issue highlights the key importance of preventing deterioration in kidney function in patients with kidney cancer 68,69,78,79 .…”