title: The natural history of renal function after surgical management of renal cell carcinoma: Results from the Canadian Kidney Cancer Information System.
abstract: Patients who undergo surgical management of renal cell carcinoma (RCC) are at risk for chronic kidney disease and its sequelae. This study describes the natural history of renal function after radical and partial nephrectomy and explores factors associated with postoperative decline in renal function.
  
  
  
  This is a multi-institutional cohort study of patients in the Canadian Kidney Cancer Information System who underwent partial or radical nephrectomy for RCC. Estimated glomerular filtration rate (eGFR) and stage of chronic kidney disease were determined preoperatively and at 3, 12, and 24 months postoperatively. Linear regression was used to determine the association between postoperative eGFR and type of surgery (radical vs. partial), duration of ischemia, ischemia type (warm vs. cold), and tumor size.
  
  
  
  With a median follow-up of 26 months, 1,379 patients were identified from the Canadian Kidney Cancer Information System database including 665 and 714 who underwent partial and radical nephrectomy, respectively. Patients undergoing radical nephrectomy had a lower eGFR (mean = 19ml/min/1.73m2lower) at 3, 12, and 24 months postoperatively (P<0.001). Decline in renal function occurred early and remained stable throughout follow-up. A lower preoperative eGFR and increasing age were also associated with a lower postoperative eGFR (P<0.01). Ischemia type and duration were not predictive of postoperative decline in eGFR (P>0.05). Severe renal failure (eGFR<30ml/min/1.73m2) developed postoperatively in 12.5% and 4.1% of radical and partial nephrectomy patients, respectively (P<0.001).
  
  
  
  After the initial postoperative decline, renal function remains stable in patients undergoing surgery for RCC. Patients undergoing radical nephrectomy have a greater long-term reduction in renal function compared with those undergoing partial nephrectomy. Ischemia duration and type are not predictive of postoperative renal function when adhering to generally short ischemia durations.
authors.affiliation: Department of Urology, Dalhousie University and QEII Health Sciences Centre, Halifax, Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Mason
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Dalai Lama School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Dalai Lama School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Olli
authors.initials: O
authors.lastname: Saarela
authors.affiliation: Division of Urology, McGill University, Montreal, Québec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Department of Surgery (Urology) and Surgical Oncology, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Jewett
authors.affiliation: Department of Surgery (Urology) and Surgical Oncology, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.affiliation: Division of Urology, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Division of Urology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jun
authors.initials: J
authors.lastname: Kawakami
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Moore
authors.affiliation: Division of Urology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Morash
authors.affiliation: Department of Urologic Sciences, University of British Colombia, British Colombia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.affiliation: Department of Urology, Dalhousie University and QEII Health Sciences Centre, Halifax, Canada. Electronic address: rrendon@dal.ca.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Rendon
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D050377:Cold Ischemia; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000503:physiopathology; D052096:Warm Ischemia; D055815:Young Adult
keywords: Partial nephrectomy; Radical nephrectomy; Renal cell carcinoma; Renal failure; Renal function