Predicting renal functional outcomes after surgery for renal cortical tumours

A multifactorial analysis

Lamont J. Barlow, Ruslan Korets, Melissa A. Laudano, Mitchell Benson, James McKiernan

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Study Type - Therapy (case series) Level of Evidence 4 Objective: To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery. Patients and Methods: We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m2); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes. Results: In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m2. After ≥3 months from surgery, 108/209 (52%) patients developed new-onset eGFR of <60 mL/min/1.73m2. On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P = 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P = 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured. CONCLUSION Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment. Journal Compilation

Original languageEnglish (US)
Pages (from-to)489-492
Number of pages4
JournalBJU International
Volume106
Issue number4
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Kidney
Glomerular Filtration Rate
Chronic Renal Insufficiency
Nephrectomy
Neoplasms
Diet Therapy
Kidney Neoplasms
Renal Insufficiency
Multivariate Analysis
Hypertension
Therapeutics

Keywords

  • glomerular filtration rate
  • nephrectomy
  • patient characteristics
  • renal cell carcinoma
  • treatment outcome

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Predicting renal functional outcomes after surgery for renal cortical tumours : A multifactorial analysis. / Barlow, Lamont J.; Korets, Ruslan; Laudano, Melissa A.; Benson, Mitchell; McKiernan, James.

In: BJU International, Vol. 106, No. 4, 01.01.2010, p. 489-492.

Research output: Contribution to journalArticle

Barlow, Lamont J. ; Korets, Ruslan ; Laudano, Melissa A. ; Benson, Mitchell ; McKiernan, James. / Predicting renal functional outcomes after surgery for renal cortical tumours : A multifactorial analysis. In: BJU International. 2010 ; Vol. 106, No. 4. pp. 489-492.
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abstract = "Study Type - Therapy (case series) Level of Evidence 4 Objective: To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery. Patients and Methods: We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m2); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes. Results: In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m2. After ≥3 months from surgery, 108/209 (52{\%}) patients developed new-onset eGFR of <60 mL/min/1.73m2. On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P = 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P = 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured. CONCLUSION Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment. Journal Compilation",
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