title: Impact of renal surgery for cortical neoplasms on lipid metabolism.
abstract: OBJECTIVE
  To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease (CKD).
  
  
  METHODS
  We conducted a two-centre retrospective analysis of 905 patients (mean age 57.5 years, mean follow-up 78 months), who underwent RN (n = 610) or PN (n = 295) between July 1987 and June 2007. Demographics, preoperative and postoperative hyperlipidaemia were recorded. De novo hyperlipidaemia was defined as that ocurring ≥6 months after surgery in cases where laboratory values met National Cholesterol Education Program Adult Treatment Panel III definitions. The Kaplan-Meier method was used to assess freedom from de novo hyperlipidaemia. Multivariable analysis was conducted to determine the risk factors for de novo hyperlipidaemia.
  
  
  RESULTS
  There were no significant differences with respect to demographics, preoperative glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) (P = 0.123) and hyperlipidaemia (P = 0.144). Tumour size (cm) was significantly larger in the RN group vs the PN group (7.0 vs 3.7; P < 0.001). Significantly greater postoperative GFR <60 mL/min/1.73 m(2) was noted in the RN group (45.7 vs 18%, P < 0.001). Significantly, more de novo hyperlipidaemia developed in the RN group than in the PN group (23 vs 6.4%; P < 0.001). The mean time to development of hyperlipidaemia was longer for PN than for RN (54 vs 44 months; P = 0.03). Five-year freedom from de novo hyperlipidaemia probability was 76% for RN vs 96% for PN (P < 0.001). Multivariable analysis showed that RN (odds ratio [OR] 2.93; P = 0.0107), preoperative GFR <60 mL/min/1.73 m(2) (OR 1.98; P = 0.037) and postoperative GFR <60 mL/min/1.73 m(2) (OR 7.89; P < 0.001) were factors associated with hyperlipidaemia development.
  
  
  CONCLUSIONS
  Patients who underwent RN had a significantly higher incidence of and shorter time to development of de novo hyperlipidaemia. RN and pre- and postoperative eGFR <60 mL/min/1.73 m(2) were associated with development of hyperlipidaemia. Further follow-up and prospective investigation are necessary to confirm these findings.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jabaji
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wake
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Patterson
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
keywords: hyperlipidaemia; lipid; partial nephrectomy; radical nephrectomy; renal cell carcinoma; triglycerides