Patients with preserved renal function who undergo surgery for localized renal masses (cT1-T2N0M0) are at increased risk for acute kidney injury (AKI) and clinically significant chronic kidney disease (CKD), especially if they have higher-complexity tumors, according to investigators presenting at the European Association of Urology’s 38th Annual Conference in Milan, Italy.
The findings are from a study of 2469 patients with localized renal masses, of whom 1063 (43%), 947 (38%), and 459 (19%) had low-, intermediate-, and high-complexity tumors, respectively. All patients had a preoperative estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or higher and a normal contralateral kidney.
At hospital discharge, 8.7%, 14%, and 31% had AKI, respectively, investigator Alessio Pecoraro, MD, of Coreggi Hospital, University of Florence in Italy, reported on behalf of his team. At 60 months, 91%, 87%, and 79% of patients in these groups were free of clinically significant CKD, which the investigators defined as an eGFR less than 45 mL/min/1.73 m2.
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On multivariable analysis, patients with intermediate- and high-complexity tumors had significant 1.5- and 3.0-fold increased odds of AKI compared with those who had low-complexity tumors. Patients with a history of hypertension had significant 1.3-fold increased odds of AKI. Compared with patients who underwent partial nephrectomy, those who underwent radical nephrectomy had significant 10.2-fold increased odds of AKI.
A Cox regression analysis showed that age-adjusted Charlson Comorbidity Index, preoperative eGFR, tumor complexity, and radical nephrectomy significantly predicted the risk for clinically significant CKD. Each 10 mL/min/1.73 m2 increase in preoperative eGFR was associated with a 42% lower risk for clinically significant CKD. Compared with low-complexity tumors, intermediate- and high-complexity tumors were associated with 1.8- and 2.7-fold increased risks for clinically significant CKD, respectively. CKD risk was increased 3.9-fold among patients who underwent radical vs partial nephrectomy.
“The risk of acute kidney injury and de novo clinically significant CKD in elective patients with a localized renal mass and preserved baseline renal function is not clinically negligible, especially in those with higher-complexity tumors,” Dr Pecoraro told attendees. “While baseline non-modifiable patient/tumor-related characteristics modulate this risk, partial nephrectomy should be prioritized over radical nephrectomy to maximize nephron preservation if oncological outcomes are not jeopardized.”
Reference
Pecoraro A, Roussel E, Amparore D, et al. New-onset chronic kidney disease after surgery for localized renal masses in patients with two kidneys and preserved renal function: A contemporary multicenter study. Presented at: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0341.
