ELEVATED SERUM CREATININE AND ACUTE KIDNEY INJURY FOLLOWING RADICAL TUMOUR NEPHRECTOMY

RJ ELLIS1,2, SJ DEL VECCHIO1,2, KL NG1,2, EM PASCOE3, CM HAWLEY1,3,4, DW JOHNSON1,3,4, G DIMESKI5, DA VESEY1,4, JS COOMBES6,7, C MORAIS1, RS FRANCIS1,3,5, ST WOOD1,2,*, GC GOBE1,6,*

1 Kidney Disease Research Group, Diamantina Institute, University of Queensland, Brisbane, QLD, 2 Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, 3 Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, QLD, 4 Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, 5Department of Chemical Pathology, Princess Alexandra Hospital, Brisbane, QLD, 6 UQ NHMRC Centre for Research Excellence (CKD.QLD), Royal Brisbane and Women’s Hospital, Brisbane, QLD, 7 School of Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, * Joint senior authors

Aim: To characterise factors associated with significantly elevated serum creatinine (SCr) within seven days of radical tumour nephrectomy (RN).

Background: RN for localised kidney neoplasms has excellent oncological outcomes, however is associated with a risk of adverse renal function postoperatively. Post-nephrectomy AKI has been reported to predict the development of CKD in RN patients.

Methods: The study population consisted of 130 patients managed for renal tumours at a single centre from June 2013 to December 2016. The primary outcome was AKI (SCr increased 50% from preoperative baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase between preoperative baseline and postoperative zenith within seven postoperative days, assessed using multivariable linear regression analysis.

Results: Overall, 130 patients were included in the study (mean age 60.1±11.8 years, 62% male, with median baseline SCr 85 [66-104] µmol/L). Following RN, the mean percentage increase in SCr in the first week was 55±29%; 77 (59%) patients experienced AKI. Independent predictors of postoperative AKI were male gender (OR 2.67; 95%CI: 1.01, 6.93), urine albumin-creatinine ratio (OR: 0.66; 95%CI: 0.47, 0.91), preoperative eGFR (OR: 1.03; 95%CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95%CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (OR 0.34; 95%CI: 0.12, 0.95). Independent predictors of SCr percentage increase were male gender (β: 12.0; 95%CI: 2.69, 21.3), urine albumin-creatinine ratio (β: -3.36; 95%CI: -6.55, -0.16), preoperative eGFR (β: 0.38; 95%CI: 0.10, 0.66), laparoscopic nephrectomy (β: 12.7; 95%CI: 1.05, 24.3) and obesity (β: 9.94, 95%CI: 0.61, 19.3).

Conclusions: Male gender, lower levels of albuminuria, higher preoperative eGFR and laparoscopic nephrectomy were independently associated with a higher likelihood of short-term kidney functional impairment following RN.

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