Predictive factors for the development of chronic renal insufficiency after renal surgery: a multicenter study.
OBJECTIVE
To evaluate which factors affecting changes in postoperative renal function after conducting radical nephrectomy or partial nephrectomy.


METHODS
Data on patients who underwent operations for renal cell carcinoma between 2000 and 2010 at multiple institutions were collected. Patient characteristics including preoperative estimated glomerular filtration rate (EGFR) were investigated, and types of surgery and postoperative results were evaluated. Renal insufficiency was defined as an EGFR <60 ml/min/1.73 m(2). Cox proportional hazard regression analysis was used to investigate which factors were associated with chronic renal insufficiency after surgery.


RESULTS
A total of 2,454 patients were included for evaluation; 1,502 patients underwent radical nephrectomy, whereas 952 patients underwent partial nephrectomy. The mean follow-up period was 44.48 ± 27.04 months (range, 12-120 months). Factors affecting EGFR were age, diabetes, hypertension, surgical procedure, and preoperative creatinine level (p < 0.001). Factors affecting postoperative renal insufficiency were age, surgical procedure, serum creatinine level, and EGFR.


CONCLUSIONS
The risk for developing post-nephrectomy renal insufficiency in patients who underwent radical nephrectomy was higher than those who underwent partial nephrectomy. Factors affecting post-nephrectomy renal insufficiency were age, preoperative serum creatinine level, and preoperative EGFR. In addition to radical nephrectomy, patient >58 years with a preoperative serum creatinine >1.03 mg/ml, and EGFR <73 ml/min/1.73 m(2) had a higher probability of developing post-nephrectomy chronic renal insufficiency.
Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yong Sun
YS
Choi
Yong Hyun
YH
Park
Yong-June
YJ
Kim
Seok Ho
SH
Kang
Seok-Soo
SS
Byun
Sung-Hoo
SH
Hong
D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors
D003404:Creatinine