Postoperative elevation in creatine kinase and its impact on renal function in patients undergoing complex partial nephrectomy.
OBJECTIVE
To identify the risk factors associated with development of postoperative elevation of creatine kinase (CK) and study its effect on renal function in patients who underwent complex multifocal partial nephrectomy (PN).


METHODS
Patients who underwent PN at National Cancer Institute between January 2007 and December 2012 were included in the study. Elevated serum CK was defined as >2000 U/L. Kidney function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR). Changes were reported as percent change from preoperative values and compared using the Wilcoxon test. Regression analysis was performed to identify the predictors of elevation in CK and decline in eGFR.


RESULTS
From 407 total cases, 207 had adequate CK data for analysis. Median number of tumors removed was 3 (1-70). Median peak CK was 1458 (82-36,788). Forty-two percent developed CK elevation >2000 U/L. Factors associated with postoperative elevation of CK > 2000 were young age (p = 0.009), high BMI (p = 0.003) and operating room time (p < 0.001). Although CK > 2000 was associated with significantly greater decline in eGFR (37.4 vs. 20.3 %, p < 0.001) in immediate postoperative period, this change largely resolved to a much less clinically relevant (9.2 vs 3.3 %, p = 0.040) change after 3 months. On multivariate analysis, postoperative elevation in CK was not found to be an independent factor determining renal function at 3 months.


CONCLUSIONS
In our cohort, a significant proportion of patients developed CK elevations >2000 U/L. While patients with elevated CK had more decline in eGFR in immediate postoperative period, postoperative elevations of CK did not appear to impact overall long-term renal function in patients undergoing PN.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Abhinav
A
Sidana
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Annerleim
A
Walton-Diaz
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Hong
H
Truong
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
M Minhaj
MM
Siddiqui
Department of Perioperative Medicine, Clinical Research Center, National Institutes of Health, Bethesda, MD.
Ning
N
Miao
Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Johanna
J
Shih
Department of Perioperative Medicine, Clinical Research Center, National Institutes of Health, Bethesda, MD.
Andrew
A
Mannes
Department of Urology, Upstate Medical University, Syracuse, NY.
Gennady
G
Bratslavsky
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
W Marston
WM
Linehan
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Adam R
AR
Metwalli
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000201:enzymology; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine; D003402:Creatine Kinase
Creatine kinase; Partial nephrectomy; Renal cell cancer; Rhabdomyolysis