Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

Abstract

Objective To analyze the association of hypertension and/or diabetes mellitus on renal function after partial nephrectomy in patients with normal baseline kidney function. Methods We identified 453 patients with baseline estimated glomerular filtration rate ≥60 that underwent robotic partial nephrectomy for a cT1 renal mass from 2008 to 2014 using a multi‐institutional database. The association between estimated glomerular filtration rate and time (pre‐partial nephrectomy to 24 months post‐partial nephrectomy) was compared between 269 (59.4%) patients with preoperative hypertension and/or diabetes mellitus and 184 (40.6%) patients with neither hypertension nor diabetes mellitus using a multivariable model adjusting for confounders. Results The estimated glomerular filtration rate significantly decreased over time for both groups compared with baseline (average units/month: 1.8974 hypertension/diabetes mellitus, 1.2163 no hypertension/diabetes mellitus; P < 0.0001), and the estimated glomerular filtration rate decrease per month reduced over time (P < 0.0001). The estimated glomerular filtration rate began to increase at approximately 12 months for the hypertension/diabetes mellitus group, and at approximately 18 months for the no hypertension/diabetes mellitus group. Although a greater initial decline in the estimated glomerular filtration rate after partial nephrectomy was observed for the hypertension/diabetes mellitus group (0.68 units/month), this was not statistically significant (P = 0.0842); and while the rate of recovery from this decline was faster for the hypertension/diabetes mellitus group, this also was not statistically significant (P = 0.0653). The predicted estimated glomerular filtration rate was similar (83 mL/min/1.73 m2) for both groups 24 months after partial nephrectomy. Conclusions There seems to be no significant association between hypertension, diabetes mellitus and renal functional outcome after partial nephrectomy in patients with normal baseline glomerular filtration rate. Renal function declines after partial nephrectomy, but then it recovers, irrespective of the presence of hypertension or diabetes mellitus.

Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model

“…It was reported that surgery had less impact on renal functions and survival when compared with medical causes of CKD 34 . In contrast, Beksac et al 35 found that HT and DM were not associated with poor renal functional outcomes following robotic PN in patients with cT1 disease and normal preoperative renal function (eGFR ≥ 60 mL/min/1.73 m 2 ). Similarly, another study investigating progression to CKD in patients undergoing PN for renal tumours showed that the presence of comorbidities such as coronary artery disease, DM, or HT was not a significant independent predictor of an increased risk of higher CKD stage in the long‐term (ranging 3 to 18 months) 15 .…”

Metabolic Syndrome Predicts Worse Perioperative Outcomes in Patients Treated With Partial Nephrectomy for Renal Cell Carcinoma

“…The association between MetS and early adverse perioperative outcomes after PN has been poorly investigated [5][6][7][8][9] . However, obesity 10,[12][13][14][15]17 , hypertension 20,21 and diabetes 21,[23][24][25] have been previously related to higher complication rates after PN. These analyses did not account for the simultaneous effect of other MetS components.…”

“…However, there are no robust data to indicate whether or not MetS predicts early adverse outcomes after partial nephrectomy (PN) [5][6][7][8][9] . Nonetheless, several previous reports examined the effect of individual MetS components, namely either obesity [10][11][12][13][14][15][16][17][18] or hypertension [19][20][21] or diabetes [21][22][23][24][25] , on perioperative outcomes after PN, without adjusting for possible combined effect of other MetS components. Moreover, none of previous studies addressed the possible synergistic effect of multiple MetS components on perioperative complications after PN.…”

Editorial Comment to Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function

“…2,3 The authors of the present study sought to clarify what role, if any, the presence of chronic kidney disease risk factors should play in clinical decision-making. 4 They investigated 453 patients who had normal renal function before undergoing robotic PN, and analyzed renal functional outcomes based on a patient history of diabetes mellitus (DM) and/or hypertension (HTN). Using a multivariable model for prediction of the estimated glomerular filtration rate (eGFR), they found that although there was an initial steeper decline in renal function after robot-assisted PN among patients with these comorbidities, this effect was negated by a greater recovery of function at 2 years, when no difference in the predicted eGFR between patients with DM and/or HTN and "healthy" individuals was recorded.…”

“…However, studies thus far have failed to show the impact of patient comorbidities on postoperative renal function . The authors of the present study sought to clarify what role, if any, the presence of chronic kidney disease risk factors should play in clinical decision‐making . They investigated 453 patients who had normal renal function before undergoing robotic PN, and analyzed renal functional outcomes based on a patient history of diabetes mellitus (DM) and/or hypertension (HTN).…”