Incidence and risk factors of chronic kidney disease in korean patients with t1a renal cell carcinoma before and after radical or partial nephrectomy

Sung Han Kim, Sang Eun Lee, Sung Kyu Hong, Chang Wook Jeong, Yong Hyun Park, Yong-June Kim, Seok Ho Kang, Sung-Hoo Hong, Won Suk Choi, Seok-Soo Byun
Japanese Journal of Clinical Oncology 2013, 43 (12): 1243-8

OBJECTIVE: The aim of the study was to investigate the incidence of chronic kidney disease in patients with T1a renal cell carcinoma both before and after partial or radical nephrectomy, and to assess risk factors for chronic kidney disease.

METHODS: From January 2001 to December 2011, 1928 patients with a single renal mass ≤4 cm undergoing partial nephrectomy or radical nephrectomy with the existence of a normal contralateral kidney were retrospectively reviewed for the evaluation of preoperative chronic kidney disease, and reviewed only 1676 patients for the postoperative chronic kidney disease. The estimated glomerular filtration rates were used to define chronic kidney disease <60 ml/min/1.73 m(2) by the Modification of Diet in Renal Disease equation. Demographics and clinicopathological parameters were evaluated to determine the risk factors with the development of chronic kidney disease both before and after surgery.

RESULTS: Chronic kidney disease was found preoperatively in 10.0% (n = 192) of patients; 16.1% (n = 269) of patients developed chronic kidney disease postoperatively, including 102 (6.1%) chronic kidney disease patients >65 years of age. Between the non-chronic kidney disease and chronic kidney disease patients, male gender (odds ratio 3.55 vs. 3.78, respectively) and diagnostic age (odds ratio 1.04 vs. 1.05) were significantly distinctive common risk factors for chronic kidney disease both before and after surgery (P < 0.002). In addition, hypertension (odds ratio 0.46), serum albumin (odds ratio 0.23) and calcium (odds ratio 2.06) were significant as preoperative risk factors (P < 0.015), and preoperative serum creatinine (odds ratio 1.90) and surgical type (partial nephrectomy or radical nephrectomy; odds ratio 11.89) were significant as postoperative risk factors (P < 0.030).

CONCLUSIONS: Old, male hypertensive patients with a small renal mass would be better candidates for partial nephrectomy to prevent postoperative chronic kidney disease.

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