Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF).
Patients who underwent PN with a preoperative estimated glomular filtration rate > 60 mL/min/1.73m2 were retrospectively examined at 8 European urologic centers. The occurrence of new onset CKD ≥ stage III after surgery (sCKD) was defined as the primary endpoint. Group comparisons and risk correlations were determined. Based on this data, a risk stratification model for sCKD was developed.
Of the 1315 patients with NPRF included, 249 (18.9%) developed sCKD after a median follow-up of 44 months (range, 6-255 months). Pair analysis and univariable regression revealed age, arterial hypertension, American Society of Anesthesiologists score, tumor stage, surgical approach, intraoperative blood loss, perioperative blood transfusions and preoperative CKD stage as predictors for sCKD development. Multivariate analysis confirmed perioperative blood transfusion (hazard ratio [HR], 2.96; P ≤ .0001), age (≥ 55 years; HR, 2.60; P = .0002), tumor stage (> pT1; HR, 2.15; P = .025), and preoperative CKD stage (stage II vs. I; HR, 3.85; P ≤ .0001) as independent risk factors. A model that stratified patient risk for new onset CKD was highly significant (P < .0001).
Every fifth patient with NPRF developed sCKD following PN. Elderly patients with higher tumor stage and who require blood transfusion appear to be at increased risk. Based on our risk stratification, patients with ≥ 2 risk factors are candidates for an early, nephrologic follow-up.
Clinical genitourinary cancer. 2020 May 20 [Epub ahead of print]
Malin Nientiedt, Riccardo Bertolo, Riccardo Campi, Umberto Capitanio, Selcuk Erdem, Önder Kara, Tobias Klatte, Alessandro Larcher, Maria Carmen Mir, Idir Ouzaid, Eduard Roussel, Maciej Salagierski, Frank Waldbillig, Maximillian Christian Kriegmair
Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: ., Department of Urology, "San Carlo di Nancy Hospital", Rome, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey., Urology Department, School of Medicine, Kocaeli University, Kocaeli, Turkey., Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK., Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France., Unit of Urogenital, Abdominal and Plastic Surgery, Biomedical Science Group, KU Leuven University, Leuven, Belgium., Department of Urology, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland., Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.