title: Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma.
abstract: OBJECTIVE
  To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To identify predictors of renal function decline after surgery, thereby allowing the identification of patients likely to be ineligible for cisplatin-based chemotherapy in the adjuvant setting.
  
  
  METHODS
  We retrospectively identified 374 patients treated with RNU for UTUC at three centres between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation before RNU and at early (1-5 months after RNU) and late (>5 months) time points after RNU. Only patients deemed eligible for cisplatin-based chemotherapy before RNU (preoperative glomerular filtration rate [GFR] ≥60 mL/min/1.73 m(2) ) were included. Multivariable analysis identified the preoperative predictors of eGFR after RNU at early postoperative and late postoperative time points.
  
  
  RESULTS
  A total of 163 patients had an eligible early post-RNU eGFR measurement and 172 had an eligible late eGFR measurement. The median eGFR declined by 32% and did not show a significant trend toward recovery over time (P = 0.4). On multivariable analysis preoperative eGFR and patient age were significantly associated with early and late postoperative eGFR, while Charlson comorbidity index score was significantly associated with late postoperative eGFR alone.
  
  
  CONCLUSIONS
  In patients with normal preoperative eGFR (≥60 mL/min/1.73 m(2) ), renal function decreases by one-third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre-RNU eGFR closer to 60 mL/min/1.73 m(2) (lower eGFR in the present cohort) are more likely to be ineligible for adjuvant cisplatin-based chemotherapy regimens because of renal function loss after RNU.
authors: Penn State Hershey Medical Center, Hershey, PA, USA.
authors: Matthew
authors: M
authors: Kaag
authors: Landon
authors: L
authors: Trost
authors: R Houston
authors: RH
authors: Thompson
authors: Ricardo
authors: R
authors: Favaretto
authors: Vanessa
authors: V
authors: Elliott
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Alexandra
authors: A
authors: Maschino
authors: Emily
authors: E
authors: Vertosick
authors: Jay D
authors: JD
authors: Raman
authors: Guido
authors: G
authors: Dalbagni
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002295:Carcinoma, Transitional Cell / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000503:physiopathology / Q000601:surgery*
keywords: chemotherapy; chronic kidney disease; kidney; nephroureterectomy; transitional cell carcinoma; urothelial carcinoma