Adverse renal outcomes in subjects undergoing nephrectomy for renal tumors: a population-based analysis

Abstract

Background: There has been increasing interest in determining renal outcomes after nephrectomy for renal tumors. Previous studies have not assessed all relevant risk factors, including proteinuria. Objective: We sought to determine the risk and predictors for the development of adverse renal outcomes in a population-based cohort of subjects undergoing partial or complete nephrectomy. Design, Setting, and Participants: A large population-based data set was used to identify all subjects undergoing nephrectomy in Alberta, Canada, from 2002 to 2007 using administrative codes. Comorbid conditions were determined using validated algorithms, and baseline estimated glomerular filtration rate (eGFR) and proteinuria status were determined. Measurements: Postsurgical outcomes of end-stage renal disease, acute dialysis, chronic kidney disease (CKD) (eGFR < 30 mL/min per 1.73 m(2)), and rapidly progressive CKD (eGFR < 60 mL/min per 1.73 m(2) and eGFR loss ≥ 4 mL/min per 1.73 m(2) per year) were assessed. The risk and risk factors for developing the composite renal outcome were determined using a multivariable Cox proportional hazards model. Results and Limitations: Of 1151 subjects, 10.5% developed an adverse renal outcome over a mean of 32 mo. Complete (vs. partial) nephrectomy was associated with a hazard ratio (HR) of 1.75 (95% confidence interval [CI], 1.02-2.99) for the primary outcome, as was lower baseline eGFR. Subjects with proteinuria were more likely to experience the primary outcome (42% vs. 9%), conferring an adjusted HR of 2.40 (95% CI, 1.47-3.88). Conclusions: Clinically important adverse renal outcomes are common in patients undergoing nephrectomy for renal tumors. In addition to baseline eGFR and the extent of the renal mass removed, proteinuria is a strong independent risk factor. Assessment of proteinuria, in addition to other risk factors, should be performed to inform prognosis and the optimal treatment strategy.

Predictors of new‐onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population‐based analysis

“…This is similar to other studies, for example, the Charlson comorbidity index was found to associate with clinically significant CKD in a Canadian populationbased study. 32 The association between age and postoperative newonset CKD is also a common finding. 33 As the effect of age was only partially mediated by nephrectomy type, this indicates that age associates with CKD through other paths, which is reflective of the general population, where the average annual eGFR reduction for persons aged ≥40 years is 0.75-1.00 mL/min per 1.73 m 2 .…”

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

“…2 Many other retrospective studies assessing different populations and utilizing various measures of renal function validated these results. 67,[77][78][79] Other studies have demonstrated the association between worsening renal function and increased risk of cardiovascular events and death. Go et al laid the foundation for this work in their study analyzing over 1,000,000 patients from the Kaiser Permanente system in Northern California.…”

Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms

“…In recent studies conducted among patients who underwent a radical procedure, lower preoperative eGFR, older age, and history of comorbidities were associated with lower postoperative eGFR (8,9), whereas older age, history of comorbidities, and tobacco use have been independently associated with the development of CKD following nephrectomy (10)(11)(12)(13). Notably, not all patients develop CKD, and indeed some patients experience improved renal function after surgery (5).…”