Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease

  • Andrew Silagy Memorial Sloan Kettering Cancer Center
  • Emily Zabor Memorial Sloan Kettering Cancer Center
  • Roy Mano Memorial Sloan Kettering Cancer Center
  • Renzo DiNatale Memorial Sloan Kettering Cancer Center
  • Julian Marcon Memorial Sloan Kettering Cancer Center
  • Mahyar Kashani
  • Kyle Blum Memorial Sloan Kettering Cancer Center
  • Eduard Reznik Memorial Sloan Kettering Cancer Center
  • Edgar Jaimes Memorial Sloan Kettering Cancer Center
  • Jonathan Coleman Memorial Sloan Kettering Cancer Center
  • A. Ari Hakimi Memorial Sloan Kettering Cancer Center
  • Paul Russo Memorial Sloan Kettering Cancer Center
Keywords: chronic kidney disease, kidney cancer, nephrectomy, dialysis, estimated glomerular filtration rate

Abstract

Introduction: We evaluated the trajectory of estimated glomerular filtration rate (eGFR) after kidney surgery in patients with kidney cancer and chronic kidney disease (CKD).

Methods: We identified 1204 consecutive patients in our institutional database with preoperative CKD undergoing partial or radical nephrectomy from 1998–2016. Postoperative eGFR was tracked, with patients censored when receiving dialysis or kidney transplantation. A multivariable mixed-effects models assessed associations between preoperative baseline patient and tumor characteristics, and longitudinal eGFR. The Kaplan-Meier method and multivariable Cox regression were used to estimate overall survival, cancer-specific survival, and cumulative incidence of dialysis.

Results: Preoperatively, 892 (74.1%), 271 (22.5%), and 41 (3.4%) patients had CKD stage 3a, 3b, and 4/5, respectively. There were 55 patients dialyzed and 355 deaths (99 from kidney cancer). Median followup was 8.1 years, with 25 781 postoperative eGFR measurements. Factors associated with decreasing eGFR postoperatively included radical nephrectomy, male gender, older age, increased body mass index (BMI), and cardiovascular risk factors. We observed a significant interaction effect between time from surgery and preoperative CKD stage: the eGFR of stage 3a patients improved, while stage ≥3b declined (p<0.001). The two-year and five-year cumulative incidence of dialysis was 1.8% (1.1–2.6%) and 3.1% (2.2–4.2%), respectively. The cumulative incidence of dialysis, with death as a competing event, significantly differed by preoperative CKD stage.

Conclusions: Preoperative CKD stage ≥3b is independently associated with a higher risk of declining renal function, dialysis, and mortality. With careful selection, patients with preoperative CKD withstand kidney surgery with low rates of dialysis.

Author Biographies

Andrew Silagy, Memorial Sloan Kettering Cancer Center

aUrology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

bDepartment of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia

Emily Zabor, Memorial Sloan Kettering Cancer Center

Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Roy Mano, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Renzo DiNatale, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Julian Marcon, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Mahyar Kashani

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Kyle Blum, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Eduard Reznik, Memorial Sloan Kettering Cancer Center

Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Edgar Jaimes, Memorial Sloan Kettering Cancer Center

Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Jonathan Coleman, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

A. Ari Hakimi, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Paul Russo, Memorial Sloan Kettering Cancer Center

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Published
2020-07-27
How to Cite
Silagy, A., Zabor, E., Mano, R., DiNatale, R., Marcon, J., Kashani, M., Blum, K., Reznik, E., Jaimes, E., Coleman, J., Hakimi, A. A., & Russo, P. (2020). Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease. Canadian Urological Association Journal, 15(2), E103-9. https://doi.org/10.5489/cuaj.6485
Section
Original Research