Pre and Postoperative eGFR independent risk factor for CKD after Radical Nephrectomy

A new study found that preoperative estimated glomerular filtration rate (eGFR), age, and immediate postoperative eGFR are independent risk factors for postoperative chronic kidney disease. The study results were published in the journal BMC Cancer.  

The most common treatment for localized renal cell carcinoma is radical nephrectomy (RN). Postoperative chronic kidney disease could result from the decreased number of nephrons due to RN. Hence researchers conducted a study to understand the incidence and risk factors for CKD in patients who have received RN. 

Between January 2010 to December 2018, at Zhejiang Provincial People's Hospital, a total of 1233 patients underwent radical nephrectomy. Patients with abnormal renal function before surgery or who were lost to follow-up were excluded from the study. Five hundred patients were enrolled and their eGFR was calculated using the abbreviated MDRD equation. CKD was defined as eGFR less than 60 ml/min/1.73m2. Kaplan-Meier method was used to estimate the incidence of postoperative CKD. logistic multivariate regression analysis was used to determine the independent risk factors for CKD. 

Results: 

• Patients were followed up for a median of 40 months and CKD occurred in 189 cases.
• The 5-year cumulative incidence of CKD was 43.4%. 
• Age, sex, weight, and preoperative eGFR(P<0.05) were significantly different between the 189 patients with CKD and the remaining patients without post-nephrectomy CKD. 
• Multivariate regression analysis showed that age, preoperative eGFR of the contralateral kidney, and Immediate postoperative eGFR were independent risk factors for postoperative CKD. 

The incidence of CKD after radical nephrectomy was common. The independent risk factors for postoperative CKD are age, preoperative eGFR of the contralateral kidney, and immediate postoperative eGFR. 

Further reading: Wang, S., Liu, Z., Zhang, D. et al. The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma. BMC Cancer 22, 1138 (2022). https://doi.org/10.1186/s12885-022-10245-8