CKD-free Survival Research Articles

#2898 UNMET NEEDS AND POOR LONG-TERM RENAL OUTCOMES IN EUROPEAN PATIENTS WITH LUPUS NEPHRITIS

Abstract Background and Aims Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE), associated with substantial morbidity and increased risk of end-stage renal disease (ESRD). Despite currently used therapies, a notable proportion of patients may not achieve sustained remission, leading to adverse disease outcomes. This study aims to summarize evidence on the long-term outcomes, burden of comorbidities, and real-world (RW) effectiveness of therapy in European patients with LN. Method A targeted literature review was conducted using MEDLINE/Pubmed and Embase to identify studies in patients with LN. Search strategies were developed for each database to identify relevant peer-reviewed articles published in English from March 2012 - March 2022 and conference abstracts from 2019 – March 2022. All records were screened according to pre-specified inclusion/exclusion criteria. Only studies conducted in a European setting were summarized here. Results Of 4,216 total records, 55 studies reported long-term outcomes of LN and RW effectiveness of treatment in European adults. Up to 36% of patients with SLE developed LN, and nearly all LN cases occurred within 5 years of SLE diagnosis. Patients with LN often suffered from serious infection (19-35%), cardiovascular disease (CVD) (26%), chronic kidney disease (CKD)/ESRD (6-22%) and were more likely to experience cardio- and cerebrovascular events than patients with SLE only (p = 0.001). Patients with LN had a higher risk of mortality compared to those with SLE only or other lupus manifestations (p<0.001), and deaths were often due to infections (8-32%), CVD (22-58%), or malignancies (5-27%). CKD/ESRD also contributed to poor survival – patients with ESRD had 3-times higher risk of death compared to those with LN only (p<0.001). The majority of RW studies evaluated effectiveness of standard of care (SOC) induction and/or maintenance therapy, mostly with mycophenolate mofetil and cyclophosphamide. Treatment response rates varied across the studies likely due to heterogeneity in study design, drug dosing, and patient population; comparative studies did not find significant differences in response rates between the regimens. Overall, 30-86% of patients with LN achieved complete renal response/remission (CRR) within the first year of starting SOC therapy. However, one study reported that only 38% of patients maintained CRR while on SOC over a 5-year period, suggesting inadequate long-term maintenance on existing therapies. Patients who were non-responders (NR) after 1 year had a significantly increased risk of mortality and CKD compared to responders (p<0.005). Patients achieving CRR had significantly longer CKD-free survival compared to NR at 15 years (95% vs 55%, p<0.0001), further highlighting the value of achieving response in terms of long-term renal outcomes. Despite initial response to current therapies, 20-35% of patients experienced a renal relapse/flare while on maintenance therapy, with one study noting significantly increased risk of proteinuric flares with azathioprine compared to other maintenance therapies (p = 0.01). Limited studies focused on treatment-experienced/refractory patients, with the majority evaluating rituximab (RTX)-based regimens. After one year of therapy, 29-64% of patients with refractory LN and 35% of patients with active LN despite SOC achieved CRR on RTX or belimumab, respectively. Conclusion European adults with LN have considerable comorbidity burden and poor long-term renal outcomes. Few patients achieve and maintain remission on SOC, and a notable proportion of patients experience renal relapse despite initial response to therapy. Given the impact that achieving CRR has on long-term outcomes, there is a need for effective therapies that provide sustained remission, especially for patients with severe/refractory LN.

Kidney involvement in hereditary transthyretin amyloidosis: a cohort study of 103 patients.

ABSTRACTBackgroundHereditary transthyretin amyloidosis (ATTRv) is a disabling and life-threatening disease that primarily affects the nervous system and heart. Its kidney involvement has not been systematically studied, particularly in non-V30M mutations, and is not well known to nephrologists.MethodsWe conducted a retrospective study describing the kidney phenotype of all prevalent patients with ATTR mutations, with neurological or cardiac involvement or presymptomatic carriers, followed up in two university hospitals from the South of France between June 2011 and June 2021.ResultsA total of 103 patients were included, among whom 79 were symptomatic and 24 were presymptomatic carriers. Patients carried 21 different ATTR mutations and 54% carried the V30M mutation. After a mean follow-up of 7.9 ± 25.7 years, 30.4% of the symptomatic patients had developed chronic kidney disease (CKD) and 20.3% had a urinary protein:creatinine ratio ≥0.5 g/g. None of the presymptomatic carriers had CKD or proteinuria. In a multivariate analysis, late onset of symptoms (after 60 years), the V122I mutation and proteinuria were significantly associated with CKD. The median CKD-free survival in symptomatic patients was estimated at 81.0 years (interquartile range 77.1–84.9). It did not differ between V30M and non-V30M patients, but was lower in patients with the V122I mutation. The average age of the onset of CKD was 69.3 ± 13.0 years. In one 38-year-old V30M female who presented a kidney-predominant phenotype, treatment with patisiran resulted in remission of the nephrotic syndrome.ConclusionCKD affects almost one-third of patients with symptomatic ATTRv. The role of ATTRv per se in the development of CKD in this population remains to be determined, but some patients may benefit from specific therapies.

MO045: Kidney involvement in hereditary transthyretin amyloidosis: a cohort study of 103 patients

Abstract BACKGROUND AND AIMS Hereditary transthyretin amyloidosis (ATTR) is a disabling and life-threatening disease that primarily affects the nervous system and heart. Its kidney involvement has been poorly studied and is not well known to nephrologists. METHOD We conducted a retrospective study describing kidney phenotype of all prevalent patients with ATTR mutations, with symptomatic amyloidosis or asymptomatic carriers, followed-up in two university hospitals from the South of France, between June 2011 and June 2021. RESULTS 103 patients were included, among whom 79 were symptomatic and 24 asymptomatic carriers, and 54% carried a V30M mutation. After a mean follow-up of 7.9 ± 25.7 years, 30.4% of the symptomatic patients had developed chronic kidney disease (CKD) and 20.7% had a urinary protein/creatinine ratio ≥0.5 g/g. None of the asymptomatic carriers had CKD or proteinuria. Median CKD-free survival in the global cohort was 81.0 years, and the average age of CKD onset was 69.3 ± 13.0 years. In a multivariate analysis, late onset of ATTR symptoms (after 60 years), the V122I mutation and proteinuria were significantly associated with CKD. In a 38-year-old V30M female, who presented a kidney-predominant phenotype, treatment with Patisiran resulted in remission of the nephrotic syndrome. CONCLUSION CKD affects almost one-third of patients with symptomatic ATTR amyloidosis. The role of ATTR amyloidosis per se in the development of CKD in this population remains to be determined, but some patients may benefit from specific therapies.

Serum uric acid variability increases the risk of postoperative chronic kidney disease in patients with renal cell carcinoma after radical nephrectomy

ObjectiveSerum uric acid (SUA) level is associated with the progression of chronic kidney disease (CKD). However, little is known about the predictive value of SUA variability for postoperative CKD in patients with renal cell carcinoma after radical nephrectomy. We aimed to investigate the association of SUA variability with postoperative CKD in this population. Method85 patients with preoperative estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m2 were enrolled in this single-center retrospective study and followed up for at least 6 months. Intra-individual SUA variability was defined as the standard deviation (SD) of SUA and the patients were stratified into three groups according to the tertiles of SUA SD (the lower, middle and upper tertile). The association of SUA variability with postoperative CKD, defined as an eGFR<60 ml/min/1.73m2, was analyzed by Cox proportional hazard models and Kaplan-Meier analyses. ResultsAfter a median follow-up time of 24(10–43) months, 44(51.7%) patients developed postoperative CKD. Kaplan-Meier curves showed that patients in the lower tertile had a longer CKD-free survival time [median CKD-free survival time 74(52.2–95.8) months] than those in the middle tertile [38(19.2-56.8) months] and upper tertile [21(17.9–24.1) months] (overall generalized Wilcoxon test: P=0.001; lower vs middle tertile: P=0.001; lower vs upper tertile: P<0.001). Adjusted Cox analyses indicated that increasing SUA SD tertiles were associated with a higher risk of postoperative CKD independent of baseline SUA, mean SUA during follow-up and other confounding variables. Compared with patients in the lower tertile, the risk for developing CKD increased by 4.6-fold for patients in the middle tertile and 7.9-fold in the upper tertile, respectively. ConclusionIncreasing SUA variability was associated with an increased risk of postoperative CKD in patients with renal cell carcinoma after radical nephrectomy.

Development and Cross-Validation of a Nomogram for Chronic Kidney Disease Following Robot-Assisted Radical Cystectomy.

Introduction: We sought to identify the factors associated with deterioration of renal functions after robot-assisted radical cystectomy, and to develop a nomogram to detect the probability of progression to chronic kidney disease (CKD). Materials and Methods: A retrospective review of our prospectively maintained database. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epidemiology Collaboration creatinine formula utilizing all follow-up creatinine values. CKD was defined as stage 3b (eGFR <45 mL/minute/1.73 m2) based on the National Kidney Foundation classification. Kaplan-Meier curves were used to depict CKD-free survival. A multivariate Cox regression model was used to determine predictors for CKD and to build the perioperative nomogram. Results: The data set comprised 442 patients with a median follow-up of 25 months (12-59). Thirty-seven percent developed CKD at a median of 9 months (4-18). CKD-free survival rates at 1, 3, and 5 years were 75%, 58%, and 50%, respectively. CKD was significantly associated with preoperative eGFR (hazards ratio [HR]: 0.96, 95% confidence interval [CI]: 0.95-0.97, p < 0.01), body mass index (HR: 1.03, 95% CI: 1.01-1.05, p = 0.03), Charlson Comorbidity Index ≥3 (HR: 2.20, 95% CI: 1.35-3.58, p < 0.01), diabetes (HR: 1.59, 95% CI: 1.09-2.31, p = 0.02), 90 days postoperative strictures (HR: 4.04, 95% CI: 1.76-9.30, p < 0.01), 90 days postoperative hydronephrosis (HR: 2.26, 95% CI: 1.34-3.79, p < 0.01), 90 days recurrent urinary tract infection (HR: 1.84, 95% CI: 1.08-3.14, p = 0.02), 90 days acute kidney injury (HR: 1.70, 95% CI: 1.19-2.43, p < 0.01), and node positive disease (HR: 1.94, 95% CI: 1.31-2.86, p < 0.01). A 5-year CKD-free survival nomogram was developed. Conclusion: We have developed and cross-validated a nomogram for detecting CKD-free survival. This nomogram may have a role in counseling and follow up of patients. This study was done after the approval of the IRB committee (I-79606).

Lymphoma survivors have an increased long-term risk of chronic kidney disease

With improving lymphoma survival, late effects of therapy have emerged. Here, we describe pattern of long-term chronic kidney disease (CKD) in lymphoma survivors. Demographics, comorbidities, lymphoma histology, treatment, and outcome were recorded. Glomerular filtration rate (GFR) was recorded at diagnosis, 1, 2, 5, and 10 years. Rate of GFR decline with time and CKD-free survival were recorded. In 397 patients, median age was 55.3 (18–88), 54% were male, 60% were African Americans, 42% had hypertension (HTN), 15% had DM, 13% had hyperuricemia, 86% received chemotherapy, and 14% had baseline CKD. Total 125 (31%) patients developed CKD in 10 years after lymphoma diagnosis. Probability of CKD development increased significantly with time (23% at 1 year to 41% at 10 years). Rate of GFR decline was 4.6 mL/min/per year. Age, HTN, hyperuricemia, and DM (in young patients) predicted risk of CKD. Thus, lymphoma survivors are at substantial long-term risk of CKD development.

Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy.

Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerulopathies diagnosed in children and adolescents. This study aimed to evaluate the clinical features in and outcomes of pediatric IgAN over the last 30 years. Patients who were diagnosed before age of 18 at 20 centers in Korea were evaluated retrospectively. Of the 1154 patients (768 males, 386 females) with a median follow-up of 5 years, 5.6% (n = 65) progressed to stage 3–5 chronic kidney disease (CKD). The 10- and 20-year CKD-free survival rates were 91.2% and 75.6%, respectively. Outcomes did not differ when comparing those in Korea who were diagnosed prior to versus after the year 2000. On multivariate analysis, combined asymptomatic hematuria and proteinuria as presenting symptoms and decreased renal function at the time of biopsy were associated with progression to CKD, while remission of proteinuria was negatively associated with this outcome. Patients who presented with gross hematuria or nephrotic syndrome tended toward positive outcomes, especially if they ultimately achieved remission. While remission of proteinuria might imply that the disease is inherently less aggressive, it also can be achieved by management. Therefore, more aggressive management might be required for pediatric-onset IgAN.

Evaluation of Longitudinal Exposure to Tacrolimus as a Risk Factor of Chronic Kidney Disease Occurrence Within the First-year Post-Liver Transplantation.

Renal failure is predictive of mortality in the early postliver-transplantation period and calcineurin inhibitors toxicity is a main challenge. Our aim is to assess the impact of longitudinal tacrolimus exposure (TLE) and other variables on chronic kidney disease (CKD)-free 1-year-survival. Retrospective data of consecutive patients transplanted between 2011 and 2016 and treated with tacrolimus were collected. TLE and all relevant pre- and post-liver transplantation (LT) predictive factors of CKD were tested and included in a time-to-event model. CKD was defined by repeated estimated glomerular filtration rate (eGFR) values below 60 mL/min/1.73m2 at least for the last 3 months before M12 post-LT. Data from 180 patients were analyzed. CKD-free survival was 74.5% and was not associated with TLE. Pre-LT acute kidney injury (AKI) and eGFR at 1-month post-LT (eGFRM1) <60 mL/min/1.73m2 were significant predictors of CKD. By distinguishing 2 situations within AKI (ie, with or without hepatorenal syndrome [HRS]), only HRS-AKI remained associated to CKD. HRS-AKI and eGFRM1 <60 mL/min/1.73m2 increased the risk of CKD (hazard ratio, 2.5; 95% confidence interval, 1.2-4.9; hazard ratio, 4.8; 95% confidence interval, 2.6-8.8, respectively). In our study, TLE, unlike HRS-AKI and eGFRM1, was not predictive of CKD-free survival at 1-year post-LT. Our results once again question the reversibility of HRS-AKI.

Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis

ObjectivesShort-term predictive endpoints of chronic kidney disease (CKD) are needed in lupus nephritis (LN). We tested response to therapy at 1 year.MethodsWe considered patients with LN who underwent renal biopsy...

Impact of warm ischaemia time on postoperative renal function after partial nephrectomy for clinical T1 renal cell carcinoma: a propensity score-matched study.

To analyse the effect of prolonged warm ischaemia time (WIT) on long-term renal function after partial nephrectomy (PN), as controversy still exists as to whether prolonged WIT adversely affects the incidence of chronic kidney disease (CKD) after PN. We reviewed data from 1816 patients who underwent PN for a clinical T1 renal tumour. The propensity scores for prolonged WIT were calculated with the shorter WIT group (<30 min) matched to the longer WIT group (≥30 min) in a 2:1 ratio. Multivariate analysis was used to determine independent predictors for occurrence of postoperative CKD [defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 ] and major renal function deterioration (MRFD; defined as an eGFR decrease of ≥25% postoperatively). After propensity score matching, there was no significant difference in CKD-free survival between the two WIT groups (P = 0.787). Furthermore, longer WIT did not show any significant associations with postoperative CKD-free survival [hazard ratio (HR) 1.002, 95% confidence interval (CI) 0.989-1.015; P = 0.765) and MRFD-free survival (HR 1.014, 95% CI 1.000-1.028; P = 0.055). From further subgroup analyses using more specific WIT thresholds (≤20, 21-30, 31-40, 41-50, ≥50 min) and status of preoperative CKD, no significant differences were noted in CKD and MRFD-free survival amongst the subgroups (all P > 0.05). Prolonged WIT was not associated with increased incidence of CKD or MRFD after PN.

Does pregnancy have any impact on long term damage accrual and on the outcome of lupus nephritis?

No data are available about the impact of pregnancy on the long-term outcome of lupus nephritis.Thirty-two women with lupus nephritis with a 10-year follow-up after their first pregnancy (“women who gave birth”) and 64 matched controls with the same follow-up and who never had pregnancies (“controls”) were compared for the occurrence of SLE flares, chronic kidney disease (CKD), and SLICC/ACR Damage Index (SDI) in the post pregnancy period. The same evaluations were done before and after pregnancy in women who gave birth. The predictors of CKD and damage accrual in the whole population were studied.All patients were Caucasians and had biopsy proven LN. At conception and after 10 years, in both groups, less than 10% of patients had active renal disease (p = ns). Controls had more frequent arterial hypertension (p = 0.025). Between the two groups there was no difference in SLE flares and in CKD free survival curves (p = 0.6 and p = 0.37) during the 10-year follow-up. In both groups, the temporal trend, based on annual evaluation, of glomerular filtration rate and serum creatinine shows a significant decrease and increase respectively. However, the women who gave birth persistently maintained better values of renal function than controls during the whole follow-up (P = 0.00001). There was no difference in the CKD-free survival curves. SDI did not increase significantly in women who gave birth in comparison to controls. All the above mentioned clinical parameters were comparable before and after pregnancy in the women who gave birth.Among the basal clinical characteristics, high serum creatinine and occurrence of SLE flares predicted CKD, whereas low levels of C3, pre-existing damage score, and occurrence of SLE flares predicted SDI increase. Pregnancy was not a predictor of CKD or SDI increase.Carrying a pregnancy during inactive lupus nephritis does not seem to increase the rate of SLE flares, worsen renal prognosis or increase SDI significantly in the very long-term.

The effect of predisposing atheroembolic risk factors on renal functional recovery between laparoscopy and open technique in patients with T1-stage renal cell carcinoma who underwent partial nephrectomy: a retrospective comparison study.

The present study aimed to determine the effect of an increasing number of predisposing atheroembolic risk factors on the development of chronic kidney disease (CKD) after partial nephrectomy (PN) in patients with T1-stage renal cell carcinoma (RCC). The study included 147 patients with T1-stage RCC with a normal contralateral kidney and without preoperative CKD, who underwent open (OPN, N = 83, 56.5%) or laparoscopic PN (LPN, N = 64, 43.5%) between 2003 and 2014. Postoperative CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2. The predictive factors for CKD between OPN and LPN were statistically assessed among various known clinicopathological factors associated with renal function in PN with a significance of two-sided P value <0.05. During a median follow-up of 42 months, the recurrence rate was 0.7% (n = 1), and the rate of postoperative CKD was 11.6% (n = 17). Significant differences in CKD-free survival were observed among patients with atheroembolic risks 5-7, 3-4 and 1-2 (P = 0.027). Regarding the predictive factors for the postoperative development of CKD between OPN and LPN, a predisposing atheroembolic risk ≥3 was significant among other clinicopathological factors in multivariate analysis (hazard ratio, 3.007, P = 0.031). Patients with T1-staged RCC with ≥3 predisposing atheroembolic risk factors have a significantly higher risk of developing CKD after PN. Patients who underwent LPN had a lesser incidence of CKD development than patients who underwent OPN with ≥3 predisposing atheroembolic risk factors.

Renin-Angiotensin System Inhibitor is Associated with Lower Risk of Ensuing Chronic Kidney Disease after Functional Recovery from Acute Kidney Injury

Acute kidney injury (AKI) is an independent risk factor for ensuing chronic kidney disease (CKD). Animal studies have demonstrated that renin-angiotensin system (RAS) inhibitor can reduce ensuing CKD after functional recovery from AKI. Here we study the association between ensuing CKD and use of RAS inhibitor including angiotensin converting enzyme inhibitor or angiotensin II type 1a receptor blocker starting after renal functional recovery in our prospectively collected observational AKI cohort. Adult patients who had cardiac surgery–associated AKI (CSA-AKI) are studied. Patients with CKD, unrecovered AKI, and use of RAS inhibitor before surgery are excluded. Among 587 eligible patients, 94 patients are users of RAS inhibitor which is started and continued after complete renal recovery during median follow-up period of 2.99 years. The users of RAS inhibitor show significantly lower rate of ensuing CKD (users vs. non-users, 26.6% vs. 42.2%) and longer median CKD-free survival time (users vs. non-users, 1079 days vs. 520 days). Multivariate Cox regression analyses further demonstrate that use of RAS inhibitor is independently associated with lower risk of ensuing CKD (hazard ratio = 0.46, P < 0.001). We conclude that use of RAS inhibitor in CSA-AKI patients after renal functional recovery is associated with lower risk of ensuing CKD development.

Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score. A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of<10 or≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression-identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60mL/min/1.73m(2)). No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (-19.7) vs PN (-11.9; P= .006). De novo CKD was 40.2% after RN vs 16.3% after PN (P<.001). RENAL score≥10 (odds ratio, 6.67; P= .025) and RN among patients with RENAL score<10 (odds ratio, 24.8; P<.001) were independently associated with de novo CKD at 6months by logistic regression. Among patients with RENAL score<10, median CKD-free survival was PN 38 vs RN 16months (P= .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P= .001). RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.

MP54-01 SIGNIFICANT PREDICTORS OF CHRONIC KIDNEY DISEASE DURING POST-PUBERTAL PERIODS IN PATIENTS WITH VESICOURETERAL REFLUX

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-01 SIGNIFICANT PREDICTORS OF CHRONIC KIDNEY DISEASE DURING POST-PUBERTAL PERIODS IN PATIENTS WITH VESICOURETERAL REFLUX Minyong Kang, Hae Won Lee, and Kwanjin Park Minyong KangMinyong Kang More articles by this author , Hae Won LeeHae Won Lee More articles by this author , and Kwanjin ParkKwanjin Park More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The paucity of evidence on renal outcomes makes it difficult to manage patients with vesicoureteral reflux (VUR) who are at risk of chronic kidney disease (CKD). Here, we examine the long-term, post-surgical clinical data of patients with VUR to evaluate the clinical features as well as significant predictors of chronic kidney disease (CKD) during post-pubertal periods. METHODS We reviewed 142 consecutive patients with VUR who were treated with either endoscopic or open surgery at our institution between September 1991 and July 2013. After exclusion of patients with incomplete data, 101 patients were included in the final analysis. CKD was defined as an estimated glomerular filtration rate (eGFR) persistently less than 60 mL/min per 1.73 m2 for at least 3 months. RESULTS The median follow-up duration was 100.0 months. The median age of patients was 16 years at the time of last follow-up. Most clinical parameters, such as body mass index, eGFR, uric acid level, and blood pressure, were significantly different between pre-operative and post-pubertal states, as these clinical parameters exhibited deterioration over time. Eleven patients (10.9%) were finally diagnosed with de novo CKD during post-pubertal periods (median time to CKD diagnosis: 104.5 months). When we examined significant predictive factors of CKD, preoperative serum blood urea nitrogen, creatinine, eGFR, and uric acid levels, as well as the presence of microalbuminuria, decreased eGFR status (< 75 mL/min per 1.73 m2), and high-grade reflux (Grades IV–V) were statistically significant in the univariate analysis. In the multivariate analysis, both serum uric acid levels (hazard ratio 2.04) and the presence of high-grade reflux (hazard ratio 11.83) were identified as significant predictors of post-pubertal CKD diagnosis. Notably, patients with high-grade reflux showed a remarkably lower probability of CKD-free survival compared to those with low-grade reflux in the Kaplan-Meier analysis. In fact, the 15-year CKD-free probability was 43.5% in patients with high-grade reflux, whereas it was 84.6 % in patients with low-grade reflux. CONCLUSIONS In conclusion, one of 10 surgically treated children with VUR eventually developed de novo CKD during post-pubertal periods. Moreover, pre-operative uric acid level and the presence of high-grade reflux were significant factors predicting post-pubertal CKD in these patients. Our results provide valuable information to expand current knowledge on kidney function changes in patients with VUR during long-term follow-up after surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e664 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minyong Kang More articles by this author Hae Won Lee More articles by this author Kwanjin Park More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Higher Glomerular Filtration Rate Predicts Low Risk of Developing Chronic Kidney Disease in Living Kidney Donors

The risk of developing chronic kidney disease (CKD) among living kidney donors (LKDs) is seldom included in evaluations of patients' outcomes. Potential risk factors and new criteria for estimating the glomerular filtration rate (eGFR) indexed for body surface area (BSA) were investigated with a view to prevent the development of CKD in LKDs. We conducted a retrospective study of LKDs from May 1983 to March 2011. The Mann-Whitney U test and χ(2) test were used to analyze the male versus female groups. Survival analysis was plotted as CKD-free survival and analyzed separately by different eGFR index classifications. The Cox regression model was used to identify potential risk factors for development of CKD. A total of 105 LKDs with a mean age of 46.3±12.5years had a mean eGFR indexed for BSA of 88.9±21.5ml/min per 1.73m(2). After a mean duration of 5.4±4.9years' follow-up, eGFR dropped to 61.4±16.4ml/min per 1.73m(2) (p=0.002). Median CKD-free survival was only 5.7years. The difference between eGFR≥80ml/min per 1.73m(2) and <80ml/min per 1.73m(2) was not statistically significant (p=0.980). Multivariate Cox regression analysis showed that higher eGFR at donation (HR=0.952, p=0.0199) could be a protective factor. The receiver operating characteristic (ROC) curve for initial eGFR with best sensitivity of 52.78% and specificity of 81.40% was obtained with a cutoff value of 90.2ml/min per 1.73m(2) for preoperative eGFR. An eGFR of 90ml/min per 1.73m(2) yielded a significant survival curve (p=0.0199) after 21years of follow-up. Further classifications of eGFR >90ml/min per 1.73m(2) into 90-99ml/min per 1.73m(2), 100-109ml/min per 1.73m(2), and ≥110ml/min per 1.73m(2) were examined, but this survival curve was not statistically significant (p=0.1247). Living kidney donors will develop CKD after a long duration of follow-up if there is insufficiently high eGFR at donation. An eGFR above 90ml/min per 1.73m(2) before donation is the only factor that predicts prevention of CKD. Larger studies with longer duration of follow-up are necessary to clarify the clinical outcome of this postoperative CKD group, especially for patients with eGFR between 80 and 90ml/min per 1.73m(2).

Prognostic Factors Influencing Postoperative Development of Chronic Kidney Disease in Patients with Small Renal Tumors who Underwent Partial Nephrectomy

Background: The objective of this study was to determine factors associated with the postoperative development of chronic kidney disease (CKD) following partial nephrectomy. Patients and Methods: This study included 109 patients with normal renal function treated with partial nephrectomy for small renal tumors. Of these, 73 and 36 patients underwent open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN), respectively. Results: Among several parameters, there was a significant difference only in the ischemia time between the OPN and LPN groups. During the median observation period of 53.4 months, CKD, defined as estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m², developed in 29 (39.7%) and 14 (38.9%) patients in the OPN and LPN groups, respectively. Univariate analysis identified age at surgery, diabetes and preoperative eGFR as significant predictors of the postoperative development of CKD; however, only age at surgery and preoperative eGFR appeared to be independently related to CKD-free survival. In fact, there was a significant difference in the CKD-free survival between patients without any independent risk factor and those with at least one of these independent risk factors. Conclusions: Careful management following partial nephrectomy is necessary for elderly patients and/or those with impaired renal function, even mild, before surgery.

Desk set revisited: Reference librarians, reality, & research systems' design

To determine if partial nephrectomy (PN) confers a renal functional benefit compared to radical nephrectomy (RN) for clinical T2 renal masses (T2RM) when adjusting for tumor complexity characterized by the RENAL nephrometry score.A 2-center study of 202 patients with T2RM undergoing RN (122) or PN (80) (median follow-up, 41.5 months). RN and PN cohorts were subanalyzed according to RENAL sum as a categorical variable of <10 or ≥10. Primary outcome was median change in estimated glomerular filtration rate (ΔeGFR) between preoperative to 6 months postoperative. Logistic regression–identified prognostic factors and survival models analyzed association between the RENAL sum and the freedom from de novo chronic kidney disease (CKD; eGFR<60 mL/min/1.73m2).No significant differences existed between PN and RN for RENAL score. ΔeGFR was greater in RN (−19.7) vs PN (−11.9; P = .006). De novo CKD was 40.2% after RN vs 16.3% after PN (P <.001). RENAL score ≥10 (odds ratio, 6.67; P = .025) and RN among patients with RENAL score <10 (odds ratio, 24.8; P <.001) were independently associated with de novo CKD at 6 months by logistic regression. Among patients with RENAL score <10, median CKD-free survival was PN 38 vs RN 16 months (P = .001). Cox proportional hazard demonstrated decreasing risk of CKD for PN vs RN from RENAL 10 (hazard ratio, 0.836) to RENAL 6 (hazard ratio, 0.003; P = .001).RN is independently associated with decreased renal function compared to PN for T2RM with RENAL sum ≤10, but not >10, with larger relative decrease in eGFR for each decrease in RENAL sum. Further investigation is required to determine optimal candidates for PN in T2RM.