Abstract: SA-PO196
AKI After Radical Nephrectomy as Risk Factor for CKD: Retrospective Analysis from an Italian Cancer Center
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Foramitti, Marina, ASST Cremona, Cremona, Italy
- Cosmai, Laura, San Carlo Borromeo Hospital, Milano, Italy
- Porta, Camillo, University of Pavia, Pavia, Italy
- Pedone, Meri, ASST Santi Paolo e Carlo Borromeo - Ospedale San Carlo Borromeo, Milan, Italy, Italy
- Rizzo, Mimma, ICS Maugeri, Viggianello, Italy
- Gri, Nicole, I.R.C.C.S. Istituti Cllinici Scientifici Maugeri, Pavia, Italy
- Gallieni, Maurizio, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo - University of Milano, Milano, Italy
- Malberti, Fabio, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
Background
Radical nephrectomy is a significant risk factor for chronic kidney disease (CKD), and there are few reports on the renal outcome after radical nephrectomy for cancer. The aim of this study was to determine the incidence of AKI and whether postoperative AKI is associated with new-onset CKD after radical nephrectomy for renal cell cancer (RCC).
Methods
We conducted a retrospective study of 837 adult patients (>40 years old), from an Italian Cancer Centers with normal renal function who underwent unilateral radical nephrectomy for a solitary renal cortical tumor and were pathologically diagnosed with RCC between January 2010 and February 2019. Post-operative AKI was classed using risk, injury, failure, loss and end-stage kidney disease (RIFLE) criteria. CKD was defined as a decrease in estimated glomerular filtration rate (GFR) to <60 mL/min/1.73 m2.
Results
According with the RIFLE criteria, 250 of 278 patients fell into the AKI risk category 1, 21 patients fell into the AKI injury category and 6 patients fell into the AKI failure category. Multivariate analysis revealed as major result that higher preoperative GFR was an independent risk factor for postoperative AKI, although older age, male gender higher body mass index, smaller RCC size were independent risk factors too. New-onset CKD was more prevalent in the AKI risk group than in patients without AKI 1 year after surgery (56.1% versus 43.9%, respectively) and 3 years after surgery (52% versus 31%). Patients who experienced post-operative AKI had a 5.1-fold higher risk of new-onset CKD after multiple adjustments, that confirms other recent study.
Conclusion
AKI after radical nephrectomy in patients is a potent risk factor for new-onset CKD. Prevention of post-operative AKI, but also the assessment of kidney function pre-nephrectomy, is essential for reducing the incidence of CKD after nephrectomy.