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Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)
Ist Teil von
World journal of urology, 2022-11, Vol.40 (11), p.2771-2779
Ort / Verlag
Berlin/Heidelberg: Springer Berlin Heidelberg
Erscheinungsjahr
2022
Quelle
MEDLINE
Beschreibungen/Notizen
Purpose
To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Methods
Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)—1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR − baseline eGFR; Δ2 = 6 months eGFR − POD-1 eGFR; Δ3 = 12 months eGFR − 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up.
Results
A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05,
p
< 0.001), male gender (OR 0.44,
p
= 0.003), POD-1 AKI (OR 2.88,
p
< 0.001) and preoperative eGFR < 60 ml/min (OR 7.58,
p
< 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06,
p
< 0.001), coronary artery disease (OR 2.68,
p
= 0.007), POD-1 AKI (OR 1.83,
p
= 0.02), and preoperative eGFR < 60 ml/min (OR 7.80,
p
< 0.001) were predictors of renal function decline at 12 months. In LM models, age (
p
= 0.019), hydronephrosis (
p
< 0.001), POD-1 AKI (
p
< 0.001) and pT-stage (
p
= 0.001) influenced renal function variation (
ß
9.2 ± 0.7,
p
< 0.001) during follow-up.
Conclusion
Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.