Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy
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Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy. / Wenzel, Mike; Kleimaker, Alexander; Uhlig, Annemarie; Würnschimmel, Christoph; Becker, Andreas; Yu, Hang; Meyer, Christian P; Fisch, Margit; Chun, Felix K H; Leitsmann, Marianne.
In: SCAND J UROL, Vol. 55, No. 5, 10.2021, p. 377-382.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy
AU - Wenzel, Mike
AU - Kleimaker, Alexander
AU - Uhlig, Annemarie
AU - Würnschimmel, Christoph
AU - Becker, Andreas
AU - Yu, Hang
AU - Meyer, Christian P
AU - Fisch, Margit
AU - Chun, Felix K H
AU - Leitsmann, Marianne
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND: To test for the impact of patient comorbidities and medical risk factors on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function.MATERIALS AND METHODS: From January 2011 to December 2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 underwent PN or RN. Stratification was performed according to postoperative acute kidney injury (AKI) vs. no AKI. Moreover, logistic regression models tested for risk factors predicting postoperative AKI and subsequent new-onset chronic kidney disease (eGFR < 60 or < 45 ml/min/1.73 m2).RESULTS: Of all eligible patients, 127 (65.1%) exhibited AKI. AKI patients underwent more frequently RN (44.9 vs. 13.2% PN) and harbored more often preoperative diabetes (17.3 vs. 5.9% no diabetes), hypertension (46.5 vs. 23.5% no hypertension) and larger median tumor size (4.5 vs. 2.5 cm, all p < 0.05) than non-AKI patients. Moreover, after median follow-up of 14 months, 18.9% of AKI patients exhibited an eGFR < 60 ml/min/1.73 m2 vs. 7.4% non-AKI patients (p = 0.01). In multivariable models, hypertension and RN were risk factors for postoperative AKI (both p < 0.01). Age > 60 years and RN as well as preoperative diabetes were risk factors for postoperative eGFR < 60 or < 45 ml/min/1.73 m2 (all p < 0.05), respectively.CONCLUSIONS: Postoperative AKI is a non-negligible event especially after RN that can be further triggered by comorbidities such as diabetes and hypertension. Comorbidities should be considered in clinical decision-making for RCC surgery and patients need to be counseled about the increased risk of consecutive renal function impairment.
AB - BACKGROUND: To test for the impact of patient comorbidities and medical risk factors on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function.MATERIALS AND METHODS: From January 2011 to December 2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 underwent PN or RN. Stratification was performed according to postoperative acute kidney injury (AKI) vs. no AKI. Moreover, logistic regression models tested for risk factors predicting postoperative AKI and subsequent new-onset chronic kidney disease (eGFR < 60 or < 45 ml/min/1.73 m2).RESULTS: Of all eligible patients, 127 (65.1%) exhibited AKI. AKI patients underwent more frequently RN (44.9 vs. 13.2% PN) and harbored more often preoperative diabetes (17.3 vs. 5.9% no diabetes), hypertension (46.5 vs. 23.5% no hypertension) and larger median tumor size (4.5 vs. 2.5 cm, all p < 0.05) than non-AKI patients. Moreover, after median follow-up of 14 months, 18.9% of AKI patients exhibited an eGFR < 60 ml/min/1.73 m2 vs. 7.4% non-AKI patients (p = 0.01). In multivariable models, hypertension and RN were risk factors for postoperative AKI (both p < 0.01). Age > 60 years and RN as well as preoperative diabetes were risk factors for postoperative eGFR < 60 or < 45 ml/min/1.73 m2 (all p < 0.05), respectively.CONCLUSIONS: Postoperative AKI is a non-negligible event especially after RN that can be further triggered by comorbidities such as diabetes and hypertension. Comorbidities should be considered in clinical decision-making for RCC surgery and patients need to be counseled about the increased risk of consecutive renal function impairment.
KW - Acute Kidney Injury/epidemiology
KW - Carcinoma, Renal Cell/epidemiology
KW - Glomerular Filtration Rate
KW - Humans
KW - Kidney/physiology
KW - Kidney Neoplasms/epidemiology
KW - Middle Aged
KW - Nephrectomy/adverse effects
KW - Retrospective Studies
U2 - 10.1080/21681805.2021.1948916
DO - 10.1080/21681805.2021.1948916
M3 - SCORING: Journal article
C2 - 34427540
VL - 55
SP - 377
EP - 382
JO - SCAND J UROL
JF - SCAND J UROL
SN - 2168-1805
IS - 5
ER -
