To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR - baseline eGFR; Δ2 = 6 months eGFR - POD-1 eGFR; Δ3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up.
A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p < 0.001) during follow-up.
Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.
World journal of urology. 2022 Oct 06 [Epub ahead of print]
Alessandro Tafuri, Michele Marchioni, Clara Cerrato, Andrea Mari, Riccardo Tellini, Katia Odorizzi, Alessandro Veccia, Daniele Amparore, Aliasger Shakir, Umberto Carbonara, Andrea Panunzio, Federica Trovato, Michele Catellani, Letizia M I Janello, Lorenzo Bianchi, Giacomo Novara, Fabrizio Dal Moro, Riccardo Schiavina, Elisa De Lorenzis, Paolo Parma, Sebastiano Cimino, Ottavio De Cobelli, Francesco Maiorino, Pierluigi Bove, Fabio Crocerossa, Francesco Cantiello, David D'Andrea, Federica Di Cosmo, Francesco Porpiglia, Pasquale Ditonno, Emanuele Montanari, Francesco Soria, Paolo Gontero, Giovanni Liguori, Carlo Trombetta, Guglielmo Mantica, Marco Borghesi, Carlo Terrone, Francesco Del Giudice, Alessandro Sciarra, Andrea Galosi, Marco Moschini, Shahrokh F Shariat, Marta Di Nicola, Andrea Minervini, Matteo Ferro, Maria Angela Cerruto, Luigi Schips, Vincenzo Pagliarulo, Alessandro Antonelli
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy. ., Department of Urology, University of Chieti, Chieti, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy., Department of Urology, University of Florence, Florence, Italy., Department of Urology, Mantua Hospital, Mantua, Italy., School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Keck School of Medicine, Institute of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, Aldo Moro University, Bari, Italy., Department of Surgery, Urology Section, University of Catania, Catania, Italy., Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Unit of Urology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy., Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy., Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy., Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, "Vito Fazzi" Hospital, Lecce Piazza Filippo Muratore, 1, 73100, Lecce, Italy., Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy., Department of Urology, University of Trieste, Cattinara Hospital - ASUGI, Trieste, Italy., Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy., Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy., Department of Urology, University of Ancona, Ancona, Italy., Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy. .