Preoperative Chronic Kidney Disease Research Articles

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.

Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer.

ObjectiveTo evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy.MethodsA total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogramResultsOf the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively).ConclusionsMuscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.

Prognostic significance of PD-L1 expression on tumor cells and tumor-infiltrating mononuclear cells in upper tract urothelial carcinoma.

Immunotherapy targeting the programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway has shown promising results in several malignancies. However, the prognostic significance of PD-L1 expression remains unknown in patients with upper tract urothelial carcinoma (UTUC). This study aimed to evaluate PD-L1 expression and its association with clinicopathological characteristics and oncological outcomes in UTUC patients. PD-L1 expression on tumor cells and tumor-infiltrating mononuclear cells (TIMCs), and E-cadherin and N-cadherin expression on tumor cells were assessed by immunohistochemistry in a cohort of 162 patients with UTUC. Associations of PD-L1 expression on tumor cells and TIMCs with clinicopathological characteristics and cancer-specific survival (CSS) were evaluated. Out of 162 patients, 20 (12.3%) and 35 (21.6%) had positive PD-L1 expression on tumor cells and TIMCs, respectively. Decreased E-cadherin expression was associated with PD-L1 positivity on tumor cells (P=0.048) and PD-L1 negativity on TIMCs (P=0.033). PD-L1 expression on tumor cells was higher in patients with preoperative chronic kidney disease (CKD) stage 4-5 than in those with no CKD or CKD stage 1-3 (P=0.011). PD-L1 was differentially expressed in tumor cells and TIMCs in UTUC. Multivariate analyses revealed that PD-L1 expression on tumor cells independently predicted shorter CSS (P=0.012), whereas PD-L1 expression on TIMCs independently predicted longer CSS (P=0.034).

Autologous Blood Donation Before Hepatectomy in Patients With Chronic Kidney Disease

Autologous blood is sometimes collected before hepatectomy. The usefulness of autologous blood donation (ABD) has been reported in several studies. However, the relationship between ABD and CKD has never been studied. The aim of this study was to clarify the relationship between preoperative autologous blood donation (ABD) and chronic kidney disease (CKD) in anemia. Between January 2006 and December 2012, 70 patients made 2 ABDs ≥ 600 mL before hepatectomy. CKD stages were based on estimated glomerular filtration rates. Univariate analyses were performed using the Mann–Whitney U test for continuous variables and the chi-square test for nominal variables. Patients at CKD stages &amp;lt; G3b (n = 60) and ≥ G3b (n = 10) were compared. There were no significant differences in hemoglobin level at the initial hospital visit or total volume of ABD between the 2 groups. However, hemoglobin levels just before the first ABD, the second ABD, and resection, and just after resection were significantly lower in the CKD ≥ G3b group than those in the &amp;lt; G3b group (P &amp;lt; 0.05). CKD stage contributes to reductions in hemoglobin levels after ABD. We recommend the use of erythropoietin in CKD ≥ G3b cases that include ABDs.

Retroperitoneal Laparoscopic Partial Nephrectomy for Tumors Larger than 7 cm in Renal Cell Carcinoma: Initial Experience of Single-Institution.

To report our initial experience dealing with retroperitoneal laparoscopic partial nephrectomy (LPN) for tumors larger than 7 cm in renal cell carcinoma (RCC). A total of 15 patients with malignant tumors larger than 7 cm underwent retroperitoneal LPN at our institution. Patient baseline demographics, perioperative outcomes, pathological characteristics, and estimated glomerular filtration rate (eGFR) were analyzed retrospectively in our collected database. The tumor size is 7.5 (7.1-9.0) cm. Nine (60.00%) patients, 4 (26.67%) patients, and 2 (13.33%) patients suffered from preoperative chronic kidney disease (CKD) at stage I, II, and III, respectively. The median operating time was 121 (90-330) minutes and the warm ischemia time (WIT) was 29 (12-45) minutes, with the estimated blood loss of 50 (10-1200) mL. The preoperative eGFR was 81.26 mL/min per 1.73 m2 (ranging from 56.15 to 140.47), eGFR on 1 and 30 days postoperative was 70.49 mL/min per 1.73 m2 (ranging from 50.32 to 137.73) and 75.13 mL/min per 1.73 m2 (ranging from 54.07 to 142.99), respectively. At last follow-up, the eGFR was 72.78 mL/min per 1.73 m2 (ranging from 51.28 to 137.86); no stage migration for CKD was observed. Major complications included 2 patients requiring blood transfusions and 1 patient performing renal vein suture as well as single leak. Our initial experience suggests that retroperitoneal LPN maybe a feasible, safe, and effective procedure for selected tumors larger than 7 cm in RCC, with the advantage of renal function preservation and acceptable major surgical complications. Tumor size might not be the contraindication of LPN in the treatment of selected tumors.

Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma? A multicenter propensity score-matched analysis.

PurposeThe aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU).ResultsThe median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007).MethodsA total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups.ConclusionsPreoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.

Monocentric Evaluation of Chimney Versus Fenestrated Endovascular Aortic Repair for Juxtarenal Abdominal Aortic Aneurysm

With approval of on-label fenestrated (F-) endovascular aortic repair (EVAR), concerns regarding long-term patency and endoleaks (ELs) after chimney graft (CG)-EVAR were raised. To add supportive data on the value of this technique, we chose to report the midterm results of CG-EVAR in a single center with standardized methods and to compare them to F-EVAR. A retrospective analysis of prospectively gathered data from January 2010 to January 2015 was conducted, and patients with excessive comorbidities for open repair treated by CG-EVAR or F-EVAR were included. Ninety patients were treated by F-EVAR (88 men, 198 targets vessels) and 31 by CG-EVAR (26 men, 39 targets vessels, 12.9% treated in emergency; P=0.001). Mean age was significantly higher in the CG group (71.3±8.2years in the FG group vs. 75.3±6.6; P=0.02), and there were significantly more patients suffering from preoperative chronic kidney disease (CKD) (13 [14.4%] treated by F-EVAR vs. 12 [38.7%]; P=0.009). Target vessels were successfully reconstructed in 99.0% (196/198 target vessels) vs. 97.4% (38/39 target vessels) of cases (P=0.3). In-hospital mortality was significantly higher after CG-EVAR (3.3% vs. 16.1%; P=0.03). Incidence of acute kidney injury and CKD did not differ significantly between both groups. At 12 and 24months, overall survival was 91.4% after F-EVAR vs. 82.1% and 81.8% vs. 69.0% (P=0.4), estimated freedom from aneurysm related reintervention was 93.3% vs. 82.1% and 84.9% vs. 82.1% (P=0.6), and target vessel's primary patency rate was 97.5% vs. 89.9% (P=0.06), respectively. Freedom from type I EL's survival was significantly higher after F-EVAR at 12 and 24months (100% vs. 89.0% and 97.7% vs. 89.0%; P=0.01), but aneurysm maximum transverse diameter decrease did not differ significantly. There are potential advantages to CG-EVAR with off-the-shelf availability, versatility, and low-profile devices. In this series, patients treated by CG-EVAR showed promising and durable midterm results compared with F-EVAR. CG-EVAR and F-EVAR should not be apprehended as opposed strategies but more as complementary ones, while the best indications for CG-EVAR are clarified.

A Nationwide Analysis of Kidney Autotransplantation

There are limited data regarding outcomes of patients underwent kidney autotransplantation. This study aims to investigate outcomes of such patients. The nationwide inpatient sample database was used to identify patients underwent kidney autotransplantation during 2002 to 2012. Multivariate analyses using logistic regression were performed to investigate morbidity predictors. A total of 817 patients underwent kidney autotransplantation from 2002 to 2012. The most common indication of surgery was renal artery pathology (22.7%) followed by ureter pathology (17%). Overall, 97.7 per cent of operations were performed in urban teaching hospitals. The number of procedures from 2008 to 2012 were significantly higher compared with the number of them from 2002 to 2007 (473 vs 345, P < 0.01). The overall mortality and morbidity of patients were 1.3 and 46.2 per cent, respectively. The most common postoperative complications were transplanted kidney failure (10.7%) followed by hemorrhagic complications (9.7%). Obesity [adjusted odds ratio (AOR): 9.62, P < 0.01], fluid and electrolyte disorders (AOR: 3.67, P < 0.01), and preoperative chronic kidney disease (AOR: 1.80, P = 0.03) were predictors of morbidity in patients. In conclusion, Kidney autotransplantation is associated with low mortality but a high morbidity rate. The most common indications of kidney autotransplantation are renal artery and ureter pathologies, respectively. A kidney transplant failure rate of 10.7 per cent was observed in patients with kidney autotransplantation. The most common postoperative complication was hemorrhagic in nature.

Compensatory structural and functional adaptation after radical nephrectomy for renal cell carcinoma according to preoperative stage of chronic kidney disease. Choi DK, Jung SB, Park BH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG.J Urol. 2015 Oct;194(4):910-5. [Epub 2015 Apr 28]. doi: 10.1016/j.juro.2015.04.093.

PurposeWe investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage. Materials and methodsWe retrospectively identified 543 patients who underwent radical nephrectomy for renal cell carcinoma between 1997 and 2012. Patients were classified according to preoperative glomerular filtration rate as no chronic kidney disease—glomerular filtration rate 90ml/min/1.73m2 or greater (230, 42.4%), chronic kidney disease stage II—glomerular filtration rate 60 to less than 90ml/min/1.73m2 (227, 41.8%), and chronic kidney disease stage III—glomerular filtration rate 30 to less than 60ml/min/1.73m2 (86, 15.8%). Computerized tomography performed within 2 months before surgery and 1 year after surgery was used to assess functional renal volume for measuring the degree of hypertrophy of the remnant kidney, and the preoperative and postoperative glomerular filtration rate per unit volume of functional renal volume was used to calculate the degree of hyperfiltration. ResultsAmong all patients (mean age = 56.0y) mean preoperative glomerular filtration rate, functional renal volume, and glomerular filtration rate/functional renal volume were 83.2ml/min/1.73m2, 340.6cm3, and 0.25ml/min/1.73m2/cm3, respectively. The percent reduction in glomerular filtration rate was statistically significant according to chronic kidney disease stage (no chronic kidney disease 31.2% vs. stage II 26.5% vs. stage III 12.8%, P<0.001). However, the degree of hypertrophic functional renal volume in the remnant kidney was not statistically significant (no chronic kidney disease 18.5% vs. stage II 17.3% vs. stage III 16.5%, P = 0.250). The change in glomerular filtration rate/functional renal volume was statistically significant (no chronic kidney disease 18.5% vs. stage II 20.1% vs. stage III 45.9%, P<0.001). Factors that increased glomerular filtration rate/functional renal volume above the mean value were body mass index (P = 0.012), diabetes mellitus (P = 0.023), hypertension (P = 0.015), and chronic kidney disease stage (P<0.001). ConclusionsPatients with a lower preoperative glomerular filtration rate had a smaller reduction in postoperative renal function than those with a higher preoperative glomerular filtration rate due to greater degrees of functional hyperfiltration.

Impact of preoperative proteinuria on renal functional outcomes after open partial nephrectomy in patients with a solitary kidney.

PurposeTo assess the impact of proteinuria on postoperative renal function after open partial nephrectomy (OPN) in patients with a solitary kidney and analyze predictive factors for developing chronic kidney disease (CKD) stage IV or higher.Materials and MethodsPatients with a solitary kidney who underwent OPN at Tokyo Women's Medical University Hospital between 1986 and 2016 were the subjects of this study. The patients were divided into 2 groups according to the presence of preoperative proteinuria. The development rate of stage IV CKD or higher was analyzed by the Kaplan-Meier method to compare the postoperative renal function of the 2 groups. Multivariate regression analysis was used to demonstrate predictive factors for postoperative CKD progression.ResultsA total of 96 patients, including 73 without proteinuria and 23 with proteinuria, were included in this study. Patients with proteinuria were more likely to be men (95.6% vs. 64.3%, p<0.01), had a higher body mass index (25.7 kg/m2 vs. 23.5 kg/m2, p<0.01), and had a higher incidence of hypertension (69.5% vs. 39.7%, p=0.01). Patients with proteinuria had a higher probability of developing stage IV CKD or higher (p=0.0002). Lower preoperative eGFR (p<0.0001) and positive proteinuria (p=0.04) were independent predictors for CKD stage progression on multivariate analysis.ConclusionsPreoperative proteinuria and eGFR were independent predictors for developing stage IV CKD or higher after OPN. Meanwhile, surgical factors including ischaemia time and tumor size had no significant effect. This suggests that assessment of preoperative CKD stage could help stratify patients according to their risk of renal function exacerbation.

P151 - Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma?: A multicenter propensity score matched analysis

P151 - Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma?: A multicenter propensity score matched analysis

Impact of Preoperative Chronic Kidney Disease in 2,531 High-Risk and Inoperable Patients Undergoing Transcatheter Aortic Valve Replacement in the PARTNER Trial

Although preoperative renal dysfunction (RD) is associated with increased mortality and morbidity after surgical aortic valve replacement, its impact on clinical outcomes after transcatheter aortic valve replacement (TAVR) is less defined. TAVR patients in the PARTNER (Placement of Aortic Transcatheter Valves) trial with a calculable glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation were included. Patients were divided into three groups: GFR >60 mL/min (none/mild RD), GFR 31 to 60 mL/min (moderate RD), and GFR ≤30 mL/min (severe RD). Operative characteristics and clinical outcomes were analyzed. Cox regression models were used to determine multivariable predictors of 1-year all-cause mortality. A total of 2,531 inoperable or high surgical risk patients from the PARTNER trial and continued access registries had a calculable GFR level: 767 (30%) had normal renal function or mild RD, 1,473 (58%) had moderate RD, and 291 (12%) presented with severe RD. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for the cohort was 11.5%, and it was highest in those with severe RD (13.8%). Patients with severe RD were more often women with a higher prevalence of diabetes. Patients with severe RD had the highest incidence of 30-day and 1-year all-cause mortality and rehospitalization. The 30-day rate of death from any cause was 10.7% in the severe RD group versus 6.0% in the moderate and mild RD groups (p= 0.01). The 1-year rate of death from any cause was 34.4% in the severe RD group versus 21.5% in the moderate RD and 20.8% in the none/mild RD groups (adjusted hazard ratio [HR] 2.24, p<0.0001 for severe versus none/mild; adjusted HR 1.14, p= 0.24 for severe versus moderate). Other significant predictors of 1-year all-cause mortality included lower body mass index, frailty, the transapical approach, a lower ejection fraction, oxygen-dependent chronic obstructive pulmonary disease, liver disease, and male sex. Preoperative severe RD is a significant predictor for 1-year mortality in TAVR patients. Careful risk stratification by the heart team is required in patients with severe preprocedural RD.

Pretreatment serum pseudocholinesterase level as a novel prognostic biomarker for upper tract urothelial carcinoma.

Pretreatment serum pseudocholinesterase (PChE) has been reported to be a prognostic predictor in several cancers. However, the prognostic significance of serum PChE level in patients with upper tract urothelial carcinoma (UTUC) remains unknown. A total of 180 patients who underwent radical nephroureterectomy (RNU) for UTUC were included in this retrospective analysis. The associations of pretreatment serum PChE levels with clinicopathological characteristics and clinical outcomes were assessed. The median (IQR) pretreatment serum PChE level was 6385 (5449-7260)IU/L, and an optimal cutoff value of 5336IU/L was set according to ROC analysis. Decreased pretreatment serum PChE levels were significantly correlated with older patient age, higher preoperative chronic kidney disease (CKD) stage and pT stage (all P<0.05). On multivariate analysis, adjusting for preoperative variables, decreased pretreatment serum PChE levels independently predicted higher pT stage (P=0.011). Moreover, Kaplan-Meier curves suggested that patients with PChE levels <5336IU/L were predicted to have a shorter overall survival (OS) and cancer-specific survival (CSS) than those with PChE levels ≥5336IU/L (both P<0.001). On multivariate analysis, decreased pretreatment serum PChE levels were significantly associated with shorter OS (HR 0.553; 95%CI 0.322-0.951; P=0.032) and CSS (HR 0.484; 95%CI 0.269-0.870; P=0.015). Decreased pretreatment serum PChE level is an independent predictor for higher pT stage, shorter OS and CSS in patients with UTUC. Pretreatment serum PChE levels may act as a simple and effective parameter to predict prognosis for UTUC patients after RNU.

Preoperative renal dysfunction and mortality after non-cardiac surgery.

Chronic kidney disease is an important preoperative risk factor. However, the association between renal dysfunction and risk of death has not been well explored in non-cardiac surgery. Two prospective observational studies in non-cardiac surgery were analysed: the European Surgical Outcomes Study (EuSOS) and the UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD). The relationship between preoperative estimated glomerular filtration rate (eGFR) and postoperative mortality was examined using multivariable Cox proportional hazards models. In EuSOS, 1580 (4·3 per cent) of 36 779 patients died in hospital; in NCEPOD, 298 (2·8 per cent) of 10 466 patients had died by 60 days after surgery. Chronic kidney disease (eGFR below 60·0 ml per min per 1·73 m(2) ) was present in 6415 patients (17·4 per cent) in EuSOS and 2262 (21·6 per cent) in NCEPOD. Preoperative chronic kidney disease was associated with older age, men, diagnosis of diabetes, cardiovascular or respiratory disease, and non-elective surgery. Preoperative eGFR categories below 60·0 ml per min per 1·73 m(2) were associated with increasing adjusted hazard ratios (HRs) for death compared with a value of 90·0 ml per min per 1·73 m(2) and above. In EuSOS, the risk of death increased with lower eGFR category, to a maximum with eGFR 15·0-29·9 ml per min per 1·73 m(2) (HR 3·37, 95 per cent c.i. 2·70 to 4·22). In NCEPOD, the risk of death also increased with declining eGFR and was maximal for eGFR below 15·0 ml per min per 1·73 m(2) (HR 3·40, 1·78 to 6·50). Renal dysfunction is an important risk factor for death after non-cardiac surgery and the risk increases steeply for patients with moderate to severe kidney dysfunction.

Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery.

Chronic kidney disease (CKD) and anemia are independent preoperative risk factors for coronary artery bypass graft (CABG) surgery. We evaluated the implications of the coexistence of these two factors and their associated prognosis for CABG surgery. We analyzed, retrospectively, consecutive patients who underwent elective CABG surgery between 2004 and 2014. The patients were classified into four groups depending on the presence or absence of preoperative CKD and anemia. We assessed the major adverse cardiac and cerebrovascular event (MACCE), defined as composite outcomes of cardio- and cerebrovascular death, revascularization through surgery or percutaneous intervention, hospitalization for congestive heart failure, and cerebral infarction. The study population consisted of 510 patients (73% male; median age 71years old), followed up for a median period of 2.8years. Multivariate analysis indicated that neither the CKD/no-anemia group [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.39-2.51, P=0.973] nor the no-CKD/anemia group (HR 1.20, 95% CI 0.69-2.09, P=0.512) had significantly poorer prognoses than the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of a MACCE (HR 2.01, 95% CI 1.01-3.98, P=0.046). The presence of both CKD and anemia in patients undergoing CABG for coronary artery disease is synergistically associated with a worse outcome.

Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome.

Acute kidney injury (AKI) is a serious complication after major surgical procedures. We examined the incidence, risk factors, and mortality of patients who sustained AKI after abdominal surgery in a large population-based cohort. All patients who underwent open and laparoscopic abdominal surgery (excluding genitourinary and abdominal vascular procedures), between 2007 and 2014 at the University Hospital in Reykjavik were identified and their perioperative serum creatinine (SCr) measurements used to identify AKI after surgery employing the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Risk factors were evaluated using multivariate logistic regression analysis and 30-day mortality compared with a propensity score-matched control group. During the 8-year period, a total of 11,552 abdominal surgeries were performed on 10,022 patients. Both pre- and postoperative SCr measurements were available for 3902 (33.8%) of the surgical cases. Of these, 264 (6.8%) were complicated by AKI; 172 (4.4%), 49 (1.3%), and 43 (1.1%) were classified as KDIGO stages 1, 2 and 3, respectively. The overall incidence of AKI for patients with available SCr values was 67.7 (99% confidence interval [CI], 57.7-78.6) per 1000 surgeries. In logistic regression analysis, independent risk factors for AKI were female sex (odds ratio [OR] = 0.68; 99% CI, 0.47-0.98), hypertension (OR = 1.75; 99% CI, 1.10-2.74), preoperative chronic kidney disease (OR= 1.68; 99% CI, 1.12-2.50), ASA physical status classification of IV (OR = 9.48; 99% CI, 3.66-29.2) or V (OR = 21.4; 99% CI, 5.28-93.6), and reoperation (OR = 4.30; 99% CI, 2.36-7.70). Patients with AKI had greater 30-day mortality (18.2% vs 5.3%; P < 0.001) compared with propensity score-matched controls. AKI is an important complication of abdominal surgery. In addition to sex, hypertension, and chronic kidney disease, ASA physical status classification is an independent predictor of AKI. Individuals who develop AKI have substantially worse short-term outcomes, including higher 30-day mortality, even after correcting for multiple patient- and procedure-related risk factors.

Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma

ObjectivesTo investigate the prevalence, temporal trends, and predictors of postoperative acute kidney injury (AKI) in a large cohort of patients with renal cell carcinoma treated with radical or partial nephrectomy. MethodsBetween January 1998 and December 2010, patients who underwent radical or partial tumor nephrectomy were identified within the Nationwide Inpatient Sample. First, prevalence and temporal trends of AKI were analyzed. Second, predictors of AKI were identified using multivariable regression analyses. Third, associations between AKI and in-hospital complications, length of stay, hospital costs, and in-hospital mortality were evaluated using logistic regression models adjusted for clustering. ResultsOf total 253,046 patients, 5.5% (14,303 in radical and 3,525 in partial nephrectomy) experienced AKI. Rates of AKI significantly increased from 2.0% in 1998 to 10.4% in 2010 (P<0.001). Predictors of AKI included male sex, radical nephrectomy, more contemporary years (2004–2010), older age, black race, higher comorbidities, higher preoperative chronic kidney disease stage, Medicare insurance status, and nephrectomy at urban hospitals (all P<0.01). Postoperative AKI during hospitalization was associated with an increased rate of in-hospital mortality, any complications, transfusion, prolonged length of stay, and higher hospital costs (all P<0.001). ConclusionsRising rates of in-hospital AKI after radical and partial nephrectomy were observed. Increasing awareness of AKI, identification of patients at risk before surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, long-term renal functional follow-up, and a well-designed prospective study, may be warranted.

MP41-01 COMPARISON OF OVERALL SURVIVAL RATE BETWEEN PARTIAL AND RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE: A MULTICENTER STUDY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-01 COMPARISON OF OVERALL SURVIVAL RATE BETWEEN PARTIAL AND RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE: A MULTICENTER STUDY Jae Seung Chung, Seok-Soo Byun, Sang Eun Lee, Sung Kyu Hong, Sang Chul Lee, Cheol Kwak, Sung Hoo Hong, Yong June Kim, and Seok Ho Kang Jae Seung ChungJae Seung Chung More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sang Eun LeeSang Eun Lee More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Sang Chul LeeSang Chul Lee More articles by this author , Cheol KwakCheol Kwak More articles by this author , Sung Hoo HongSung Hoo Hong More articles by this author , Yong June KimYong June Kim More articles by this author , and Seok Ho KangSeok Ho Kang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.168AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examine the impact of PN relative to RN on overall survival and renal function in patients with chronic kidney disease (CKD) stage III. METHODS We studied 4178 patients who underwent PN or RN for pathological T1a-T2NOMO RCC from 1988 to 2014. To investigate the relative effectiveness of PN in terms of OS according to CKD stage, we divided the RCC patients into two subgroups: CKD I-II (eGFR≥60 ml/min/1.73m2) and CKD III (30≤eGFR<60 ml/min/1.73m2). To achieve equal distributions of patients between PN and RN, we pair-matched the patients using propensity scores in terms of age, gender, diabetes, hypertension, charlson index, BMI, tumor size, preoperative kidney function. Overall survival, cancer specific survival (CSS) were estimated using the Kaplan-Meier and Cox hazard method. Renal function was evaluated by using the estimated glomerular filtration rate (eGFR). RESULTS Of 3534 patients with CKD I-II groups, 878 RN patients were matched with 878 PN patients. In CKD III group, which was comprised of 628 patients, 138 RN patients were matched with 138 PN patients. The median follow-up durations in the RN and PN arms were 52.3 and 43.2 months in CKD I-II group, 56.2 and 50.3 months in CKD III group, respectively. The 5-year OS rates after PN and RN differed in CKD I-II groups (99.4% for PN and 96.5% for RN, p=0.001). 5-year CSS rate were 99.7% for PN and 99.5% for RN (p=0.551). However, the 5-year OS rate after surgery were not different between RN and PN in CKD III-IV groups ( 97.8% vs 93.5%, p=0.069). The difference in kidney cancer specific survival (PN vs RN) was not statistically significant (p=0.524). The Cox hazard analysis showed that the operative method was a significant factor for overall survival in CKD I-II (HR 0.275, CI 0.121-0.623, p=0.002). However, PN was not beneficial in terms of OS in CKD III (HR 0.317, CI 0.086-1.172, p=0.085). PN had better postoperative renal function preservation compared to RN regardless of CKD stages. CONCLUSIONS Our study showed that PN is associated with a higher overall survival rate for patients with preoperative CKD I and II. However, benefits for PN were not observed in CKD III patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e559-e560 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jae Seung Chung More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Sung Kyu Hong More articles by this author Sang Chul Lee More articles by this author Cheol Kwak More articles by this author Sung Hoo Hong More articles by this author Yong June Kim More articles by this author Seok Ho Kang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP41-04 PREOPERATIVE PROTEINURIA IS ASSOCIATED WITH WORSE RENAL OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PARTIAL NEPHRECTOMY

INTRODUCTION AND OBJECTIVES: Proteinuria is considered an important prognostic indicator for progression of chronic kidney disease (CKD) and mortality. Our goal was to investigate the significance of preoperative proteinuria in a cohort of patients without preexisting CKD undergoing elective partial nephrectomy (PN) for T1a tumors. METHODS: We reviewed a prospectively collected IRB approved database of 837 patients undergoing nephrectomy between 1/2007 and 12/2014, at our institution. Patients with preoperative GFR >60ml/min/1.73m and available preoperative urinalysis receiving elective PN for a pathologic T1a tumor were included. Proteinuria was defined as 30mg/dL. Postoperative GFR was measured at a minimum of 3 months. GFR categories were created based on Kidney Disease: Improving Global Outcomes guidelines. Demographic, tumor specific, and intraoperative characteristics as well as postoperative renal outcomes at last follow up were analyzed. RESULTS: We included 298 patients, 25 (8.4%) of whom had preoperative proteinuria, with a mean follow up of 34 months. There were no significant differences in age, BMI, comorbidities, operative time, EBL, ischemia time, or tumor size between the two groups. Patients with pre-existing proteinuria were more likely to be black (p1⁄40.02) and have a lower pre-op GFR (81.4 vs. 87.3 ml/min, p1⁄40.05). The mean decrease in GFR after PN in those with preoperative proteinuria was 19.7 vs. 9.4 ml/min in the control group (p1⁄40.01) (Table 1). After PN, 52% of patients in the proteinuria group developed CKD vs 13% in the group without proteinuria (p1⁄4<.001) (Table 2). CONCLUSIONS: In patients without pre-operative CKD undergoing elective PN, the presence of proteinuria is associated with larger decreases in GFR and higher probability of progression to CKD after surgery. Assessment of proteinuria preoperatively may aid in proper treatment selection for patients with small kidney tumors.

Preoperative Plasma Fibrinogen Level Represents an Independent Prognostic Factor in a Chinese Cohort of Patients with Upper Tract Urothelial Carcinoma.

BackgroundIncreased plasma fibrinogen is thought to contribute to tumor progression and metastasis. The association of plasma fibrinogen with clinicopathological characteristics, and the optimal cutoff with an ideal predictive value has not been fully determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the clinical significance of this parameter in a Chinese cohort of patients with UTUC.MethodsA retrospective study was conducted to analyze the clinical data of 184 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). An optimal cutoff was set for further analysis according to validated web-based software. The associations of plasma fibrinogen with clinicopathological characteristics and survival were assessed. Multivariate analyses were performed to determine the independent prognostic factors.ResultsElevated plasma fibrinogen was significantly associated with tumor necrosis, lymph node involvement, and a higher preoperative CKD stage, pathological tumor stage and grade (all P < 0.05). Kaplan-Meier analysis showed that plasma fibrinogen ≥ 3.54 g/L predicted a poorer overall and cancer-specific survival than < 3.54 g/L (P < 0.001 for both). Multivariate analyses revealed that elevated preoperative plasma fibrinogen was an independent negative prognostic factor for overall survival (HR = 2.026; 95% CI: 1.226–3.349; P = 0.006) and cancer-specific survival (HR = 1.886; 95% CI: 1.019–3.490; P = 0.043).ConclusionsIncreased plasma fibrinogen was an independent prognostic risk factor for poor outcomes in UTUC. This parameter may serve as an effective biomarker with easy accessibility for evaluating prognosis for patients with UTUC.