title: Recovery of renal function after radical nephrectomy and risk factors for postoperative severe renal impairment: A Japanese multicenter longitudinal study.
abstract: OBJECTIVE
  To investigate longitudinal changes in renal function after radical nephrectomy, and to explore risk factors of postoperative severe renal impairment in a Japanese multicenter cohort.
  
  
  METHODS
  The present retrospective study included 701 patients who had no metastasis, end-stage kidney disease or bilateral kidney cancer, who underwent radical nephrectomy and who were followed up for at least 1 year. The longitudinal change in postoperative renal function during a 10-year follow-up period was evaluated according to the presence or absence of potential risk factors including greater age, chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease. A slope of annual change in estimated glomerular filtration rate was analyzed using a linear mixed model. Associations between the potential risk factors and a >50% estimated glomerular filtration rate decrease were evaluated using a multivariate Cox regression model.
  
  
  RESULTS
  Overall, the postoperative estimated glomerular filtration rate recovered over time with a significant positive slope of 0.34 mL/min/1.73 m(2)/year. Renal function did not tend to recover in patients with chronic kidney disease, hypertension, diabetes mellitus or cardiovascular disease. The multivariate analysis showed that greater age and diabetes mellitus were independent risk factors for severe renal impairment.
  
  
  CONCLUSIONS
  Overall, patients who had deteriorated renal function immediately after radical nephrectomy recovered over time. However, patients with chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease did not tend to recover renal function postoperatively. Greater age and diabetes mellitus were independent risk factors for a >50% decrease in estimated glomerular filtration rate.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawamura
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Ishioka
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Matsuoka
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Urology, Tobu Chiiki Hospital, Tokyo, Japan.
authors.forename: Chizuru
authors.initials: C
authors.lastname: Arisawa
authors.affiliation: Department of Urology, JA Toride Medical Center, Toride, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Okuno
authors.affiliation: Department of Urology, Saitama Red Cross Hospital, Saitama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Noro
authors.affiliation: Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011184:Postoperative Period; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: kidney cancer; linear mixed model; radical nephrectomy; renal function