A lower estimated glomerular filtration rate (eGFR) following radical nephrectomy is associated with more rapid progression to end-stage kidney disease (ESKD), according to study findings presented at the AUA2021 Virtual Experience.
The findings “are critically important in patient counseling and surgical planning, particularly for patients with risk factors for renal deterioration,” investigator Diego Aguilar Palacios, MD, of the Glickman Urological and Kidney Institute at Cleveland Clinic in in Cleveland, Ohio, concluded during an oral presentation.
Dr Aguilar Palacios and colleagues reviewed data from 3966 patients at high risk for renal deterioration who underwent radical nephrectomy within the Veterans Affairs Health System. The study included patients with preoperative hypertension, diabetes, proteinuria, or pre-existing chronic kidney disease.
They defined ESKD as an eGFR less than 15 mL/min/1.73 m2. Patients were stratified by new baseline GFR (NB-GFR), defined as the final eGFR value within 3-12 months after surgery.
Within the first year after nephrectomy, 206 patients (5%) progressed to ESKD. The mean preoperative eGFR of those patients was 22 mL/min/1.73 m2. The risk of progression to ESKD increased with decreasing NB-GFR. Results showed that 15.8% and 46.9% of patients with an NB-GFR of 30-45 and 15-30 mL/min/1.73 m2 progressed to ESKD, respectively, compared with 8.7% of those with an NB-GFR of 45-60 mL/min/1.73 m2, the investigators reported. The time to progression was 71.6 and 48.0 months, respectively. All-cause death rates also increased with decreasing NB-GFR (34.8% and 44.7%, respectively).
Aguilar Palacios D, Schumacher F, Markt S, Willson B, Campbell S, Abouassaly R. The risk of progression to end stage renal disease after radical nephrectomy in a high-risk population: A descriptive analysis from the Veterans Affairs. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Poster MP42-16.