Abstract
BackgroundRadical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic kidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before surgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of renal function in patients undergoing radical nephrectomy.MethodsBetween January 1995 and December 2012, we performed 511 consecutive radical nephrectomies for patients with RCC. We retrospectively studied data from 109 patients who had regular postoperative follow-up of renal function for at least five years. The patients were divided into non-CKD and pre-CKD based on a preoperative estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 or <60 mL/min/1.73 m2, respectively. The ACI was quantitatively measured by abdominal computed tomography before surgery. The patients in each group were stratified between low and high ACIs. Variables such as age, sex, comorbidities, and pre- and postoperative renal function were compared between patients with a low or high ACI in each group. Renal function deterioration-free interval rates were evaluated by Kaplan-Meier analysis. Factors independently associated with deterioration of renal function were determined using multivariate analysis.ResultsThe median age, preoperative eGFR, and ACI in this cohort were 65 years, 68 mL/min/1.73 m2, and 8.3%, respectively. Higher ACI (≥8.3%) was significantly associated with eGFR decline in both non-CKD and pre-CKD groups. Renal function deterioration-free interval rates were significantly lower in the ACI-high than ACI-low strata in both of the non-CKD and pre-CKD groups. Multivariate analysis showed that higher ACI was an independent risk factor for deterioration of renal function at 5 years after radical nephrectomy.ConclusionsAortic calcification burden is a potential predictor of deterioration of renal function after radical nephrectomy.Trial registrationThis study was registered as a clinical trial: UMIN000023577
Highlights
Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic kidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before surgery
It is suggested that CKD as a consequence of surgery may be associated with a relatively lower risk of progression and mortality than CKD attributed to medical disorders [4, 5], any CKD is associated with an increased risk of cardiovascular events and all-cause mortality in large, population based studies [6,7,8]
In the non-CKD group, longitudinal evaluation of estimated glomerular filtration rate (eGFR) revealed that the postoperative median eGFR at 5 years in patients with low and high aortic calcification index (ACI) were 58 and 50 ml/min/1.73 m2, respectively (P = 0.0061)
Summary
Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic kidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before surgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of renal function in patients undergoing radical nephrectomy. The clinical relevance of the aortic calcification index (ACI) with regard to postoperative renal function outcome in patients undergoing radical nephrectomy has not been well studied. We hypothesized that preexisting aortic calcification may play a crucial role in the deterioration of renal function after radical nephrectomy and investigated the contribution of the ACI in predicting postoperative renal function in such patients. This study was registered as a clinical trial: UMIN000023577 (http://rctportal.niph.go.jp/ en/detail?trial_id=UMIN000023577)
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