818 CHRONIC KIDNEY DISEASE PRIOR AND FOLLOWING NEPHRON-SPARING SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2010818 CHRONIC KIDNEY DISEASE PRIOR AND FOLLOWING NEPHRON-SPARING SURGERY Melanie Clark, Sergey Shikanov, Jay Raman, Benjamin Smith, Matthew Kaag, Paul Russo, Jeffrey C. Wheat, J. Stuart Wolf, Surena Matin, William Huang, Arieh Shalhav, and Scott E. Eggener Melanie ClarkMelanie Clark Chicago, IL More articles by this author , Sergey ShikanovSergey Shikanov Chicago, IL More articles by this author , Jay RamanJay Raman Hershey, PA More articles by this author , Benjamin SmithBenjamin Smith Hershey, PA More articles by this author , Matthew KaagMatthew Kaag Hershey, PA More articles by this author , Paul RussoPaul Russo New York, NY More articles by this author , Jeffrey C. WheatJeffrey C. Wheat Ann Arbor, MI More articles by this author , J. Stuart WolfJ. Stuart Wolf Ann Arbor, MI More articles by this author , Surena MatinSurena Matin Houston, TX More articles by this author , William HuangWilliam Huang New York, NY More articles by this author , Arieh ShalhavArieh Shalhav Chicago, IL More articles by this author , and Scott E. EggenerScott E. Eggener Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We performed a multi-institutional retrospective cohort study to evaluate baseline renal function of patients who underwent partial nephrectomy for renal tumors and determine rates of progression to higher stages of chronic kidney disease (CKD). METHODS Preoperative and postoperative serum creatinine values were obtained from patients who underwent partial nephrectomy at six institutions with a normal contralateral kidney and had baseline CKD of I (GFR > 90 ml/min/1.73m2), II (GFR = 60 – 89 ml/min/1.73m2), or III (GFR = 30 – 59 ml/min/1.73m2). Patients with baseline CKD IV and V were excluded. The Modification of Diet in Renal Disease Study (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine CKD stage. The endpoint was change in CKD at long-term follow-up (3–18 months). A multivariate logistic regression model tested the association of newly acquired CKD III with age, sex, race, BMI, surgical approach, hypertension, diabetes, coronary artery disease, tumor size and margins, renal vessel clamping, ischemia time, hypothermia, and estimated blood loss. RESULTS A total of 1,228 patients underwent partial nephrectomy with follow-up creatinine data at least 3 months following surgery. Mean baseline GFR was 75 ml/min/1.73m2. At baseline, 19% of patients had CKD I, 59% had CKD II, and 22% had CKD III. At long-term follow-up, mean post-operative GFR for patients with baseline CKD I or II was 71 ml/min/1.73m2 with 280 (29%) patients newly entering CKD III. Increasing age (OR = 1.05, p <0.001), female gender (OR = 1.80 p = 0.002), increasing tumor size (OR = 1.20, p = 0.003), clamping the renal artery and vein (B = 2.28, p = 0.054), and lower pre-operative GFR (OR = 1.05, p <0.001) were independently associated with newly acquired CKD III. The presence of co-morbid conditions did not independently predict increased risk of a higher CKD stage. CONCLUSIONS Approximately one-quarter of patients presenting for partial nephrectomy with a normal contralateral kidney have stage III CKD and an additional 29% will develop CKD III or higher following surgery. Increasing age, female gender, larger tumor size, clamping the artery and vein, and lower baseline GFR are associated with worsening kidney function following surgery. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e320 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melanie Clark Chicago, IL More articles by this author Sergey Shikanov Chicago, IL More articles by this author Jay Raman Hershey, PA More articles by this author Benjamin Smith Hershey, PA More articles by this author Matthew Kaag Hershey, PA More articles by this author Paul Russo New York, NY More articles by this author Jeffrey C. Wheat Ann Arbor, MI More articles by this author J. Stuart Wolf Ann Arbor, MI More articles by this author Surena Matin Houston, TX More articles by this author William Huang New York, NY More articles by this author Arieh Shalhav Chicago, IL More articles by this author Scott E. Eggener Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...