Does Glomerular Filtration Rate at Discharge After Partial Nephrectomy Predict Long-Term Glomerular Filtration Rate Stability?

Abstract

Introduction: Being able to predict glomerular filtration rate (GFR) plateau after partial nephrectomy (Pnx) is an important goal in providing patients with a confident projection of maintained renal function. As such, in an ethnically and socioeconomically diverse, inner city cohort of patients undergoing Pnx, we compared preoperative (pre-op) and day of discharge (DC) GFR to that of long-term GFR measured at 12-18 months to evaluate postoperative (post-op) GFR stability. Methods: A total of 162 patients who had undergone minimally invasive Pnx at a single institution between 2010 and 2016 were reviewed. Patients with the following available measurements were included: pre-op GFR, DC GFR, and long-term GFR (12-18 months after DC). Multivariate linear regression was performed to assess factors predictive of long-term GFR, including estimated blood loss, warm ischemic time, tumor size, length of stay, pre-op GFR, DC GFR, race, chronic kidney disease, diabetes mellitus, and hypertension. Results: Mean pre-op GFR, DC GFR, and long-term GFR were 70.754, 68.326, and 66.526 mL/(minute $ 1.73 m 2), respectively. Mean GFR change was-4.228 pre-op to long term and-1.800 DC to long term. No significant difference was observed between means of DC GFR and long-term GFR (p = 0.248) as well as between means of pre-op GFR and DC GFR (p = 0.062). A significant difference was observed between pre-op GFR and long-term DC GFR (p = 0.002). On multivariate analysis, both pre-op GFR (b = 0.532; 95% confidence interval [CI] = 0.256-0.808; p £ 0.001) and DC GFR (b = 0.312; 95% CI = 0.089-0.537; p = 0.007) were found to be strong predictors of long-term GFR (R 2 = 0.608). Conclusions: Long-term GFR in a highly ethnically diverse inner city population recovering from Pnx is stable relative to GFR measured at DC from the hospital. Our findings demonstrate that patients experience a GFR plateau after surgery, resulting in minimal change in renal function at a mean of 14 months post-op.

Correlation between preoperatively predicted and postoperatively observed renal function using an imaging‑based approach: A retrospective cohort study

“…Owing to intraoperative ischemic injury and excision of the renal parenchymal unit, renal function may decrease following PN. Recent mechanistic studies have revealed that acute kidney injury after PN may contribute to chronic kidney disease development and increase the risk of cardiovascular disease (3,4). A number of studies into the predictors of renal function after PN have been conducted, and determinants associated with immediate or late renal function after PN have been well established (5)(6)(7).…”