Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/24529
Title: Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease.
Austin Authors: Silagy, Andrew M;Zabor, Emily;Mano, Roy;DiNatale, Renzo;Marcon, Julian;Kashani, Mahyar;Blum, Kyle;Reznik, Eduard;Jaimes, Edgar;Coleman, Jonathan;Hakimi, A Ari;Russo, Paul
Affiliation: Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Surgery (University of Melbourne)
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Issue Date: 27-Jul-2020
Date: 2020-07-27
Publication information: Canadian Urological Association journal = Journal de l'Association des urologues du Canada 2020; online first: 27 July
Abstract: We evaluated the trajectory of estimated glomerular filtration rate (eGFR) after kidney surgery in patients with kidney cancer and chronic kidney disease (CKD). We identified 1204 consecutive patients in our institutional database with preoperative CKD undergoing partial or radical nephrectomy from 1998-2016. Postoperative eGFR was tracked, with patients censored when receiving dialysis or kidney transplantation. A multivariable mixed-effects models assessed associations between preoperative baseline patient and tumor characteristics, and longitudinal eGFR. The Kaplan-Meier method and multivariable Cox regression were used to estimate overall survival, cancer-specific survival, and cumulative incidence of dialysis. Preoperatively, 892 (74.1%), 271 (22.5%), and 41 (3.4%) patients had CKD stage 3a, 3b, and 4/5, respectively. There were 55 patients dialyzed and 355 deaths (99 from kidney cancer). Median followup was 8.1 years, with 25 781 postoperative eGFR measurements. Factors associated with decreasing eGFR postoperatively included radical nephrectomy, male gender, older age, increased body mass index (BMI), and cardiovascular risk factors. We observed a significant interaction effect between time from surgery and preoperative CKD stage: the eGFR of stage 3a patients improved, while stage ≥3b declined (p<0.001). The two- year and five-year cumulative incidence of dialysis was 1.8% (1.1-2.6%) and 3.1% (2.2-4.2%), respectively. The cumulative incidence of dialysis, with death as a competing event, significantly differed by preoperative CKD stage. Preoperative CKD stage ≥3b is independently associated with a higher risk of declining renal function, dialysis, and mortality. With careful selection, patients with preoperative CKD withstand kidney surgery with low rates of dialysis.
URI: https://ahro.austin.org.au/austinjspui/handle/1/24529
DOI: 10.5489/cuaj.6485
Journal: Canadian Urological Association journal = Journal de l'Association des urologues du Canada
PubMed URL: 32744993
ISSN: 1911-6470
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

12
checked on Mar 29, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.