title: Patients with medical risk factors for chronic kidney disease are at increased risk of renal impairment despite the use of nephron-sparing surgery.
abstract: OBJECTIVE
  To determine whether patients with normal preoperative renal function, but who possess medical risk factors for chronic kidney disease (CKD), experience poorer renal function after partial nephrectomy (PN) for renal cell carcinoma (RCC) compared with those without risk factors.
  
  
  METHODS
  The effects of age, hypertension (HTN) and diabetes mellitus (DM) on estimated glomerular filtration rate (eGFR) were investigated in 488 consecutive operations for RCC performed during 2005-2012 at six Australian tertiary referral centres; 156 patients underwent PN and 332 patients underwent radical nephrectomy (RN). We used chi-squared test and binary logistic regression to analyse new-onset CKD, and multiple linear regression to investigate determinants of postoperative eGFR.
  
  
  RESULTS
  The development of new-onset eGFR of <60 mL/min was related to undergoing RN rather than PN (risk ratio [RR] 2.7, P < 0.001), older age (RR 1.6, P < 0.001) and the presence of HTN (RR 1.6, P = 0.001) and DM (RR 1.5, P = 0.003). Patients undergoing PN were still at risk of new-onset CKD if medical risk factors were present. Whereas 7% of patients undergoing PN without CKD risk factors developed new-onset eGFR <60 mL/min, this figure increased to 24%, 30% and 42% for older age, HTN and DM, respectively. Patients with eGFR of 45-59 mL/min were more likely to progress to more severe forms of CKD and end-stage renal failure than those with eGFR of ≥60 mL/min. On multivariate analysis, RN, rather than PN, age and the presence of DM (but not HTN), predicted both the development of new-onset eGFR of <60 mL/min (R(2) = 0.37) and new-onset eGFR <45 mL/min (R(2) = 0.42).
  
  
  CONCLUSIONS
  Patients with medical risk factors for CKD are at increased risk of progressive renal impairment despite the use of PN. Where feasible, nephron-sparing surgery should be considered for these patients.
authors: Monash Health, Melbourne, Australia.
authors: Prassannah
authors: P
authors: Satasivam
authors: Royal Melbourne Hospital, Melbourne, Australia.
authors: Fairleigh
authors: F
authors: Reeves
authors: Austin Health, Melbourne, Australia.
authors: Kenny
authors: K
authors: Rao
authors: Monash Health, Melbourne, Australia.
authors: Zacchary
authors: Z
authors: Ivey
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors: Marnique
authors: M
authors: Basto
authors: St Vincent's Hospital, Melbourne, Australia.
authors: Marcus
authors: M
authors: Yip
authors: Alfred Hospital, Melbourne, Australia.
authors: Hedley
authors: H
authors: Roth
authors: Alfred Hospital, Melbourne, Australia.
authors: Jeremy
authors: J
authors: Grummet
authors: St Vincent's Hospital, Melbourne, Australia.
authors: Jeremy
authors: J
authors: Goad
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors: Daniel
authors: D
authors: Moon
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors: Declan
authors: D
authors: Murphy
authors: Monash Health, Melbourne, Australia.
authors: Sree
authors: S
authors: Appu
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.|University of Melbourne, Department of Surgery, Urology Unit, Austin Hospital, Melbourne, Australia.|Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia.
authors: Nathan
authors: N
authors: Lawrentschuk
authors: Austin Health, Melbourne, Australia.
authors: Damien
authors: D
authors: Bolton
authors: Royal Melbourne Hospital, Melbourne, Australia.
authors: Jamie
authors: J
authors: Kearsley
authors: Royal Melbourne Hospital, Melbourne, Australia.
authors: Anthony
authors: A
authors: Costello
authors: Monash Health, Melbourne, Australia.
authors: Mark
authors: M
authors: Frydenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003920:Diabetes Mellitus; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data*; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: chronic kidney disease; diabetes mellitus; glomerular filtration rate; hypertension; nephrectomy