Comparison of postoperative estimated glomerular filtration rate between kidney donors and radical nephrectomy patients, and risk factors for postoperative chronic kidney disease.

Abstract

To compare post-nephrectomy renal function between kidney donors and renal cell carcinoma patients, to evaluate trends in recovery, and to identify factors relevant to renal failure. Patients who had radical or donor nephrectomy from four different institutions between 2003 and 2012 were reviewed. Propensity score matching was carried out and 79 patients were selected for each group. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula preoperatively and postoperatively at 1, 3, 6, 12, 24 and 36 months. Mean estimated glomerular filtration rate was compared, and the difference between preoperative values and each preceding date was calculated. A multivariate logistic regression was used to determine independent factors for a decrease in estimated glomerular filtration rate to <60 mL/min/1.73 m(2) . The donor nephrectomy group showed a trend of improved estimated glomerular filtration rate recovery at 24 months and 36 months compared with the radical nephrectomy group, which was statistically significant (P = 0.028, P = 0.012). Multivariate logistic regression showed that renal cell carcinoma (odds ratio 4.605, 95% confidence interval 1.626-13.040, P = 0.004), a baseline estimated glomerular filtration rate lower than 110 (odds ratio 4.477, 95% confidence interval 1.360-14.742, P = 0.014) and age older than 40 years (odds ratio 21.616, 95% confidence interval 2.761-169.222, P = 0.003) were predictive factors for a decrease in renal function. Renal cell carcinoma is an independent risk factor for chronic kidney disease after nephrectomy. In addition, age older than 40 years and a baseline estimated glomerular filtration rate of 110 mL/min/1.73 m(2) or less seem to represent risk factors associated with chronic kidney disease after nephrectomy.