The Effect of Patient and Surgical Characteristics on Renal Function After Partial Nephrectomy

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Abstract

In this study we identified patient characteristics linked to adverse renal function outcomes after partial nephrectomy. We performed a retrospective study of 387 patients between 2006 and 2014 who underwent a partial nephrectomy at Memorial Sloan Kettering Cancer Center. In univariable analysis, we determined that advanced age at surgery, large tumor size, male sex, longer ischemia time, smoking and hypertension were linked to lower postoperative GFR. In multivariable analysis, advanced age, lower preoperative GFR and longer ischemia time were independent predictors of postoperative decline in renal function.

Background:

The purpose of the study was to identify patient and disease characteristics that have an adverse effect on renal function after partial nephrectomy.

Patients and Methods:

We conducted a retrospective review of 387 patients who underwent partial nephrectomy for renal tumors between 2006 and 2014. A line plot with a locally weighted scatterplot smoothing was generated to visually assess renal function over time. Univariable and multivariable longitudinal regression analyses incorporated a random intercept and slope to evaluate the association between patient and disease characteristics with renal function after surgery.

Results:

Median age was 60 years and most patients were male (255 patients [65.9%]) and white (343 patients [88.6%]). In univariable analysis, advanced age at surgery, larger tumor size, male sex, longer ischemia time, history of smoking, and hypertension were significantly associated with lower preoperative estimated glomerular filtration rate (eGFR). In multivariable analysis, independent predictors of reduced renal function after surgery included advanced age, lower preoperative eGFR, and longer ischemia time. Length of time from surgery was strongly associated with improvement in renal function among all patients.

Conclusion:

Independent predictors of postoperative decline in renal function include advanced age, lower preoperative eGFR, and longer ischemia time. A substantial number of subjects had recovery in renal function over time after surgery, which continued past the 12-month mark. These findings suggest that patients who undergo partial nephrectomy can experience long-term improvement in renal function. This improvement is most pronounced among younger patients with higher preoperative eGFR.

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