1
|
Yang Y, Meng L, Hu X, Li X. Renal functional outcomes after nephrectomy in patients with localized renal cell carcinoma and diabetes mellitus: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1859-1868. [PMID: 38300449 DOI: 10.1007/s11255-023-03885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/31/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION AND OBJECTIVE Diabetes mellitus (DM), one of the most common comorbidities in patients with renal cell carcinoma (RCC), was proven to be an important prognostic factor of overall survival for these patients. Regarding the influence on renal function after nephrectomy, evidence is still scant. This systematic review and meta-analysis was conducted to provide a more reliable analysis of the association between DM and long-term renal functional outcomes after nephrectomy. METHODS The PubMed, Web of Science, Embase and Cochrane Library (CENTRAL) databases were searched for eligible studies from inception to January 2023. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to evaluate the association between DM and renal functional outcomes using a random effects model. Stata 17.0 software was used for statistical analysis. RESULTS The meta-analysis included thirteen studies consisting of 8562 RCC patients who underwent nephrectomy. Preoperative comorbidity of DM was significantly associated with poor renal functional outcomes (HR = 1.91, 95% CI 1.48-2.48, p < 0.0001), regardless of ethnicity, follow-up time, body mass index (BMI) and age. However, in the radical nephrectomy subgroup, DM was not significantly associated with renal function decline (HR = 1.91, 95% CI 0.93-3.90, p = 0.0781). CONCLUSIONS The aggregate evidence indicated that preexisting DM may be associated with poor renal functional outcomes in patients with RCC after nephrectomy, especially in patients receiving partial nephrectomy. Urologists should focus more on the glycemic management of these patients after nephrectomy. More high-quality studies are needed to explore the influence of DM on renal function outcomes in postoperative patients.
Collapse
Affiliation(s)
- Yujia Yang
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Linghao Meng
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
2
|
Oh SW, Byun SS, Kim JK, Jeong CW, Kwak C, Hwang EC, Kang SH, Chung J, Kim YJ, Ha YS, Hong SH. Machine learning models for predicting the onset of chronic kidney disease after surgery in patients with renal cell carcinoma. BMC Med Inform Decis Mak 2024; 24:85. [PMID: 38519947 PMCID: PMC10960396 DOI: 10.1186/s12911-024-02473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Patients with renal cell carcinoma (RCC) have an elevated risk of chronic kidney disease (CKD) following nephrectomy. Therefore, continuous monitoring and subsequent interventions are necessary. It is recommended to evaluate renal function postoperatively. Therefore, a tool to predict CKD onset is essential for postoperative follow-up and management. METHODS We constructed a cohort using data from eight tertiary hospitals from the Korean Renal Cell Carcinoma (KORCC) database. A dataset of 4389 patients with RCC was constructed for analysis from the collected data. Nine machine learning (ML) models were used to classify the occurrence and nonoccurrence of CKD after surgery. The final model was selected based on the area under the receiver operating characteristic (AUROC), and the importance of the variables constituting the model was confirmed using the shapley additive explanation (SHAP) value and Kaplan-Meier survival analyses. RESULTS The gradient boost algorithm was the most effective among the various ML models tested. The gradient boost model demonstrated superior performance with an AUROC of 0.826. The SHAP value confirmed that preoperative eGFR, albumin level, and tumor size had a significant impact on the occurrence of CKD after surgery. CONCLUSIONS We developed a model to predict CKD onset after surgery in patients with RCC. This predictive model is a quantitative approach to evaluate post-surgical CKD risk in patients with RCC, facilitating improved prognosis through personalized postoperative care.
Collapse
Affiliation(s)
- Seol Whan Oh
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 06591, Seoul, Korea
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, 06591, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, 61469, Gwangju, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, 02841, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, 10408, Goyang, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University College of Medicine, 28644, Cheongju, Korea
- Department of Urology, College of Medicine, Chungbuk National University, 28644, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, 41404, Daegu, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, Klatte T, García-Chairez LR, González-Colmenero AD, Pallares-Méndez R, Cervantes-Miranda DE, Plata-Huerta HH, Rodriguez-Gutierrez R, Gutiérrez-González A. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis. Urol Oncol 2023; 41:113-124. [PMID: 36642639 DOI: 10.1016/j.urolonc.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/17/2022] [Accepted: 11/27/2022] [Indexed: 01/16/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.
Collapse
Affiliation(s)
- Mario Ochoa-Arvizo
- Edinburgh Medical School: Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Urology, IRCSS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Mariano García-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karla M Santos-Santillana
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Tobias Klatte
- Department of Urology, Charite-Universitaetmedizin, Berlin, Germany
| | - Luis R García-Chairez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro D González-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rigoberto Pallares-Méndez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniel E Cervantes-Miranda
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hiram H Plata-Huerta
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene- Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Gutiérrez-González
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| |
Collapse
|
4
|
Histopathologic features and parameters predicting recurrence potential of small renal masses. Curr Urol 2023. [DOI: 10.1097/cu9.0000000000000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
5
|
Abstract
Renal cell carcinoma is associated with chronic kidney disease as well as with common risk factors including hypertension and diabetes mellitus. Localized renal cell carcinoma is treated surgically and in these cases has a favorable prognosis. In particular, in those individuals with small renal masses (≤4 cm), preservation of kidney function should be prioritized. Postoperative chronic kidney disease or end-stage renal disease prevention should include baseline kidney function and risk factor assessment, nontumor renal biopsy, as well as counseling on treatment options to discuss maximizing kidney function preservation. Postnephrectomy prognosis can be determined with repeat laboratory and clinical assessment. Ultimately, early involvement of the nephrologist in a multidisciplinary team including the urology team will enable the reduction of postsurgical kidney disease related morbidity and potentially mortality.
Collapse
Affiliation(s)
- Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
| |
Collapse
|
6
|
Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
Collapse
Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| |
Collapse
|
7
|
Zhang Y, Wu T, Xie J, Yan L, Guo X, Xu W, Wang L. Effects of metabolic syndrome on renal function after radical nephrectomy in patients with renal cell carcinoma. Int Urol Nephrol 2021; 53:2127-2135. [PMID: 33459957 DOI: 10.1007/s11255-020-02759-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Nephrectomy, partial or radical, remains the standard treatment for renal cell carcinoma (RCC). However, increased risk of chronic kidney disease (CKD) must still be considered. This study aimed to evaluate the effects of concomitant metabolic syndrome (MetS) on renal function in patients with RCC after radical nephrectomy. METHODS Medical records of 310 patients who underwent radical nephrectomy for clear-cell RCC at 900th Hospital of the Joint Logistics Support Force, PLA from December 2012 to January 2017 were reviewed retrospectively. Estimated glomerular filtration rate (eGFR) and CKD stages were calculated at one week preoperative as baseline and then at postoperative 1 week, 3 months, 12 months and 24 months. MetS patients were identified and enrolled in the MetS group (n = 31), and a non-MetS group was selected by propensity score matching (n = 31). Non-neoplastic renal parenchyma specimens taken at least 2 cm from edge of tumor were evaluated. RESULTS Baseline characteristics between the two groups were comparable. At 24 months postoperative, mean eGFR levels of the MetS group were significantly lower than those in the non-MetS group (62.7 vs. 73.3 ml/min/1.73 m2; p = 0.004). CKD stages were still more severe in the MetS group than those in the non-MetS group (p = 0.006). The proportions of global sclerosis, tubular atrophy and interstitial fibrosis were all significantly more prevalent in MetS patients, compared to non-MetS patients (all p < 0.05). CONCLUSION In RCC patients with MetS, the possibility of declining eGFR and CKD progression must be considered after radical nephrectomy. Routine monitoring of renal function must be emphasized.
Collapse
Affiliation(s)
- Yong Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.,Division of Nephrology, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China
| | - Tingkun Wu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jingjing Xie
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Liqun Yan
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiuli Guo
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Weijia Xu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Liping Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China. .,Division of Nephrology, The 900th Hospital of Joint Logistic Support Force, PLA, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China.
| |
Collapse
|
8
|
Renal volume matters: Assessing the association between excisional volume loss and renal function after partial nephrectomy. Asian J Surg 2019; 43:257-264. [PMID: 31324510 DOI: 10.1016/j.asjsur.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/23/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the oncological and functional outcomes after partial nephrectomy for clinical stage T1 (cT1) renal cell carcinoma (RCC), and assess the association between excisional volume loss (EVL) and postoperative renal function. METHODS We retrospectively reviewed 150 patients with cT1 RCC undergoing partial nephrectomy from 2002 to 2016. End-point evaluation was assessed by recurrence free survival (RFS), overall survival (OS), stage III and stage IV chronic kidney disease (CKD). Regression models were used to determine the risk factors of CKD after surgery. The relationship between EVL and renal function decline was evaluated using Spearman correlation method. RESULTS Ninety patients with clinical stage T1a (cT1a) tumors and 60 patients with clinical stage T1b (cT1b) tumors were included. There were no differences in RFS, OS, and risk of stage III and stage IV CKD between the two groups. In Cox regression models, multivariate analysis showed that preoperative estimated glomerular filtration rate (eGFR) was an independent risk factor for developing stage III (hazard ratio 0.937, P < 0.001) and stage IV CKD (hazard ratio 0.929, P = 0.027). EVL was significantly associated with postoperative eGFR decrease. (Correlation Coefficient = 0.325, P = 0.003). CONCLUSIONS Patients with cT1a and cT1b RCC have comparable oncological and functional outcome after partial nephrectomy, and preoperative eGFR is an independent factor to predict developing CKD. EVL has influence on the postoperative renal function decline.
Collapse
|
9
|
Danilovic A, Ferreira TAC, Maia GVDA, Torricelli FCM, Mazzucchi E, Nahas WC, Srougi M. Predictors of surgical complications of nephrectomy for urolithiasis. Int Braz J Urol 2019; 45:100-107. [PMID: 30521174 PMCID: PMC6442129 DOI: 10.1590/s1677-5538.ibju.2018.0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis. Patients and Methods: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien - Dindo classification. Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis. Results: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien - Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End - stage renal disease with dialysis was needed post - operatively in 3.4% (5 / 144) of patients. Conclusions: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien - Dindo score > 1.
Collapse
Affiliation(s)
- Alexandre Danilovic
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Thiago Augusto Cunha Ferreira
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Fabio Cesar Miranda Torricelli
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William Carlosa Nahas
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
10
|
Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Marco DJT, Neale RE, Wood ST, Jordan SJ. Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e581-e591. [PMID: 30975606 DOI: 10.1016/j.clgc.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy. PATIENTS AND METHODS All patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m2) at 12 months after nephrectomy. RESULTS Older age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias. CONCLUSION Patient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.
Collapse
Affiliation(s)
- Robert J Ellis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia; Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia; Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - David J T Marco
- University of Melbourne, Melbourne, Australia; Centre for Palliative Care, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | |
Collapse
|
11
|
Martín OD, Bravo H, Arias M, Dallos D, Quiroz Y, Medina LG, Cacciamani GE, Carlini RG. Determinant factors for chronic kidney disease after partial nephrectomy. Oncoscience 2018; 5:13-20. [PMID: 29556514 PMCID: PMC5854289 DOI: 10.18632/oncoscience.393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/23/2018] [Indexed: 01/22/2023] Open
Abstract
The objective of this review is to evaluate the factors that determine the development or deterioration of Chronic Kidney Disease (CKD) after partial nephrectomy (PN). When current literature is reviewed, it is found that factors that influence renal function after partial nephrectomy, are multifactorial. Those are divided into pre-surgical factors, such as hypertension, diabetes mellitus, urolithiasis, obesity, metabolic syndrome among others; intra-surgical factors, like the surgical technique used, the remaining healthy tissue, the experience of the surgeon, the time and type of ischemia among others. Lastly, post-surgical factors, also impose some influence on the post-surgical renal performance. It was also found that minimally invasive surgery, in addition to its known advantages, seems to offer a greater field of action in the future that will allow more nephrons preservation in any future surgical scenario. Finally, the current trend is to perform PN on all patients, in whom surgery is technically feasible regardless of the approach used, without risking oncological outcomes, patient safety, and without being exposed to any additional complications.
Collapse
Affiliation(s)
- Oscar D Martín
- Clínica Cooperativa de Colombia, Universidad Cooperativa de Colombia - Facultad de Medicina, Villavicencio, Colombia
| | - Heilen Bravo
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Marcos Arias
- Hospital Metropolitano de Santiago (HOMS), Santiago, República Dominicana
| | - Diego Dallos
- Fundacion Universitaria Ciencias de la Salud Hospital de San Jose, Bogotá, Colombia
| | - Yesica Quiroz
- Fundacion Universitaria Ciencias de la Salud Hospital de San Jose, Bogotá, Colombia
| | - Luis G Medina
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - Raul G Carlini
- Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| |
Collapse
|
12
|
Shinzato T, Kurosawa A, Kubo T, Shimizu T, Kimura T, Nanmoku K, Yagisawa T. No significant differences in short-term renal prognosis between living kidney donors with and without diabetes. Clin Exp Nephrol 2017; 22:694-701. [PMID: 29027035 PMCID: PMC5956044 DOI: 10.1007/s10157-017-1487-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal prognosis in living kidney donors with diabetes is currently not known. In this study, we sought to investigate renal prognosis in living kidney donors with diabetes. METHODS We retrospectively investigated 241 living kidney donors who underwent nephrectomy at Jichi Medical University Hospital between January 2000 and December 2015. Donors with a follow-up period of less than 1 year were excluded. The remaining donors were divided into a diabetic group and a non-diabetic group. Their clinical parameters before donation and renal prognosis after donation were compared. RESULTS Of the 241 donors, 16 were excluded due to their follow-up period being less than 1 year. Of the remaining 225 donors, 14 were diabetic and 211 were non-diabetic. There were no significant differences in variables at pre-donation. The median follow-up period was 4.3 (1.5-10.7) and 4.6 (1.0-13.0) years in kidney donors with and without diabetes, respectively. At the end of follow-up, the estimated glomerular filtration rate was 51.7 ± 7.1 ml/min/1.73 m2 in the diabetic group and 52.1 ± 12.2 ml/min/1.73 m2 (p = 0.906) in the non-diabetic group; urine albumin excretion was 9.5 (2-251) mg/day (or mg/g creatinine) in the diabetic group and 6 (0-626) mg/day (or mg/g creatinine) in the non-diabetic group (p = 0.130); and urine protein excretion was 0.079 (0-0.41) g/day in the diabetic group and 0.051 (0-3.7) g/day in the non-diabetic group (p = 0.455). CONCLUSIONS There were no significant differences in short-term renal prognosis between kidney donors with and without diabetes.
Collapse
Affiliation(s)
- Takahiro Shinzato
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan.
| | - Akira Kurosawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Taro Kubo
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Toshihiro Shimizu
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Takaaki Kimura
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Koji Nanmoku
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| | - Takashi Yagisawa
- Department of Renal Surgery and Transplantation, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan
| |
Collapse
|
13
|
Partial nephrectomy vs. radical nephrectomy for stage I renal cell carcinoma in the presence of predisposing systemic diseases for chronic kidney disease. Kaohsiung J Med Sci 2017; 33:339-343. [PMID: 28738974 DOI: 10.1016/j.kjms.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 01/30/2023] Open
Abstract
Aim of this study is to compare the effects of partial nephrectomy (PN) and radical nephrectomy (RN) for stage I renal cell carcinoma (RCC) on renal functions in patients with diabetes mellitus (DM) and/or hypertension (HT). Charts of patients who underwent surgery for stage I RCC in our department were retrospectively reviewed and patients with DM and/or HT were enrolled. Preoperative and postoperative estimated glomerular filtration rates (eGFR) were calculated according to the Modification of Diet in Renal Disease (MDRD) formulation for both RN and PN groups. Groups were compared for patient demographics, preoperative eGFR, postoperative eGFR and ΔeGFR [(preoperative eGFR) - (postoperative eGFR)] which reflects the renal functional loss. There were 85 patients in the RN and 33 patients in the PN groups. Demographic data were similar but the patients in the PN group had smaller tumor size compared to RN group (32.2 ± 11.8 mm vs 47.1 ± 15.2 mm, p < 0.001). Preoperative eGFR did not differ between groups (75 ± 28.4 mL/min/1.73 m2 vs 75.5 ± 23.8 mL/min/1.73 m2 in RN and PN groups, p = 0.929). However, there were significant differences between groups in terms of postoperative eGFR (57.5 ± 21.7 mL/min/1.73 m2 vs 74 ± 27.5 mL/min/1.73 m2 in RN and PN groups, p < 0.001) and ΔeGFR (17.5 ± 4.2 mL/min/1.73 m2 vs 1.5 ± 0.4 mL/min/1.73 m2 in RN and PN groups, p < 0.001). Our findings favor the use of PN over RN for stage I RCC whenever feasible in patients with predisposing systemic diseases for chronic kidney disease for better preservation of renal functions.
Collapse
|
14
|
Fantin JPP, de Carvalho Neiva R, Gatti M, de Arruda PF, de Arruda JGF, Antoniassi T, Spessoto LCF, Mesquita JC, Castiglioni L, Fácio-Júnior FN. Risk factors for acute renal failure in nephrectomized patients treated in a university hospital. Transl Androl Urol 2017; 6:277-281. [PMID: 28540236 PMCID: PMC5422694 DOI: 10.21037/tau.2017.03.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background New surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital. Methods Seventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed. Results Of the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001). Conclusions An altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.
Collapse
Affiliation(s)
- João Paulo Pretti Fantin
- Resident in Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Ronaldo de Carvalho Neiva
- Resident in Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Marcio Gatti
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Pedro Ferraz de Arruda
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Thiago Antoniassi
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Luís Cesar Fava Spessoto
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - José Carlos Mesquita
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Lilian Castiglioni
- Department of Biostatistics, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| | - Fernando-Nestor Fácio-Júnior
- Department of Urology, Hospital de Base of the Medicine School in Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil
| |
Collapse
|
15
|
|
16
|
The Past, Present, and Future in Management of Small Renal Masses. JOURNAL OF ONCOLOGY 2015; 2015:364807. [PMID: 26491445 PMCID: PMC4605375 DOI: 10.1155/2015/364807] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/06/2015] [Accepted: 09/13/2015] [Indexed: 12/20/2022]
Abstract
Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.
Collapse
|
17
|
Ghandour RA, Danzig MR, McKiernan JM. Renal cell carcinoma: risks and benefits of nephron-sparing surgery for T1 tumors. Adv Chronic Kidney Dis 2015; 22:258-65. [PMID: 26088069 DOI: 10.1053/j.ackd.2015.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 01/10/2023]
Abstract
Renal cell carcinoma is the most common cancer of the kidneys that is primarily treated with surgery, including removal of part or all the involved kidney depending on size and tumor, complexity, and patient characteristics. Partial nephrectomy historically was restricted to cases of solitary kidney or bilateral tumors. It was then started for masses smaller than 4 cm and currently is even studied and justified in tumors smaller than 7 cm if surgically feasible. Although partial nephrectomy preserves kidney tissue and, therefore, delays or prevents the new onset of CKD and ESRD, radical nephrectomy is still overused even for the small tumors. Studies have shown that although this practice is driven by an easier complete removal of the kidney especially in the era of minimally invasive surgery, partial nephrectomy is successful in curing cancer and achieving excellent cancer-specific survival in addition to its benefits on cardiovascular health. Nowadays interest in preserving healthy kidney tissue is increasing to the level of studying the impact of larger volume removed around the kidney and the histopathology of that non-neoplastic tissue to predict kidney function behavior postoperatively.
Collapse
|
18
|
Schmid M, Abd-El-Barr AER, Gandaglia G, Sood A, Olugbade K, Ruhotina N, Sammon JD, Varda B, Chang SL, Kibel AS, Chun FK, Menon M, Fisch M, Trinh QD. Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma. Urol Oncol 2014; 32:1259-66. [PMID: 25129142 DOI: 10.1016/j.urolonc.2014.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/29/2014] [Accepted: 05/03/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Patients with renal cell carcinoma who were treated with radical nephrectomy (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI), and in consequence, short- and long-term adverse outcomes. We sought to identify independent predictors of 30-day AKI in patients undergoing RN or PN. MATERIALS AND METHODS Between 2005 and 2011, patients who underwent RN or PN for renal cell carcinoma within the National Surgical Quality Improvement Program data set were identified. Patients with preexisting severe renal failure, defined as a preoperative estimated glomerular filtration rate<30 ml/min/1.73 m(2), were excluded from the analyses. AKI was defined as an elevation of serum creatinine>2mg/dl above baseline or the need for dialysis within 30 days of surgery. Univariable and multivariable logistic regression analyses were used to examine the association between preoperative factors and the risk of postoperative AKI. RESULTS Overall, 1,944 (58.6%) and 1,376 (41.4%) patients underwent RN and PN, respectively. Overall, 1.8% of the patients included in the study experienced AKI within an average of 5.4 days after RN or PN. Independent predictors for AKI included obesity (odds ratio [OR] = 2.24, P = 0.04), history of neurovascular disease (OR = 5.29, P<0.001), and a preoperative chronic kidney disease stage II (OR = 10.00, P = 0.03) or stage III (OR = 26.49, P = 0.02). Furthermore, RN (OR = 2.87, P = 0.02) or the open approach (OR = 2.18, P = 0.04) was significantly associated with postoperative AKI. AKI was significantly associated with adverse postoperative outcomes, such as prolonged length of stay, occurrence of any complication, and mortality (all P <0.001). CONCLUSIONS The assessment of preoperative kidney function and comorbidity status is essential to identify patients at risk of postoperative AKI. In addition to preoperative chronic kidney disease stages II and III, neurovascular disease, obesity, and surgical approach (RN or open) represent predictors of 30-day AKI. Careful patient selection as well as preoperative planning may help reduce this unfavorable postoperative outcome.
Collapse
Affiliation(s)
- Marianne Schmid
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Giorgio Gandaglia
- Department of Urology, University Cita-Salute San Raffaele, Milan, Italy
| | - Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Kola Olugbade
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Nedim Ruhotina
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Briony Varda
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Felix K Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Schmid M, Ravi P, Abd-El-Barr AERM, Klap J, Sammon JD, Chang SL, Menon M, Kibel AS, Fisch M, Trinh QD. Chronic kidney disease and perioperative outcomes in urological oncological surgery. Int J Urol 2014; 21:1245-52. [PMID: 25041641 DOI: 10.1111/iju.12563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/15/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate baseline renal dysfunction among patients undergoing urological oncological surgery and its impact on early postoperative outcomes. METHODS Between 2005 and 2011, patients who underwent minimally-invasive or open radical prostatectomy, partial nephrectomy and radical nephrectomy, or open radical cystectomy, respectively, were identified in the National Surgical Quality Improvement Program dataset. Preoperative kidney function was assessed using estimated glomerular filtration rate and staged according to National Kidney Foundation definitions. Multivariable logistic regression was used to model the association between preoperative renal function and the risk of 30-day mortality and major complications. Furthermore the impact of chronic kidney disease on operation time and length of hospital stay was assessed. RESULTS Overall, 13,168 patients underwent radical prostatectomy (65.4%), partial nephrectomy (10.7%) and radical nephrectomy (16.1%) and radical cystectomy (7.8%), respectively; 50.1% of evaluable patients had reduced kidney function (chronic kidney disease II), and a further 12.6, 0.7 and 0.9% were respectively classified into chronic kidney disease stages III, IV, and V. Chronic kidney disease was an independent predictor of 30-day major postoperative complications (chronic kidney disease III: odds ratio 1.61, P < 0.001; chronic kidney disease IV: odds ratio 2.24, P = 0.01), of transfusions (chronic kidney disease III: odds ratio 2.14, P < 0001), of prolonged length of stay (chronic kidney disease III: odds ratio 2.61, P < 0.001; chronic kidney disease IV: odds ratio 3.37, P < 0.001; and chronic kidney disease V: odds ratio 1.68; P = 0.03) and of 30-day mortality (chronic kidney disease III: odds ratio 4.15, P = 0.01; chronic kidney disease IV: odds ratio 10.10, P = 0.003; and chronic kidney disease V: odds ratio 17.07, P < 0.001) compared with patients with no kidney disease. CONCLUSIONS Renal dysfunction might be underrecognized in patients undergoing urological cancer surgery. Chronic kidney disease stages III, IV and V are independent predictors for poor 30-day postoperative outcomes.
Collapse
Affiliation(s)
- Marianne Schmid
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|