TY - JOUR
T1 - Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy
AU - Malcolm, John B.
AU - Bagrodia, Aditya
AU - Derweesh, Ithaar H.
AU - Mehrazin, Reza
AU - DiBlasio, Christopher J.
AU - Wake, Robert W.
AU - Wan, Jim Y.
AU - Patterson, Anthony L.
PY - 2009/8
Y1 - 2009/8
N2 - Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright
AB - Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright
KW - Chronic renal insufficiency
KW - Metabolic acidosis
KW - Nephron-sparing surgery
KW - Proteinuria
KW - RCC
KW - Radical nephrectomy
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U2 - 10.1111/j.1464-410X.2009.08376.x
DO - 10.1111/j.1464-410X.2009.08376.x
M3 - Article
C2 - 19220252
AN - SCOPUS:69849100841
SN - 1464-4096
VL - 104
SP - 476
EP - 481
JO - BJU international
JF - BJU international
IS - 4
ER -