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Kidney Week

Abstract: PO1852

Identifying Patients with CKD Risk at the Time of Partial Nephrectomy

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Yang, Yihe, Northwell Health, New Hyde Park, New York, United States
  • Sharma, Purva D., Northwell Health, New Hyde Park, New York, United States
  • Jhaveri, Kenar D., Northwell Health, New Hyde Park, New York, United States
  • Bijol, Vanesa, Northwell Health, New Hyde Park, New York, United States
Background

The prevalence of chronic kidney disease is high among kidney neoplasm patients because of the overlapping risk factors. We aim to identify risk factors of eGFR decline in kidney cancer survivors post partial nephrectomy (nx).

Methods

All partial nx patients with neoplasm at Northwell Health were included (2018/7-2020/5, n=187). Clinical and histology parameters, including neoplastic and non-neoplastic pathology, were analyzed. Non-neoplastic assessment includes glomerulosclerosis(GS), interstitial fibrosis and tubular atrophy(IFTA), and a semiquantitative estimate of the severity of arterial and arteriolar sclerosis (AAS). Multivariate linear mixed model was performed. Independent variates included age, sex, hypertension, diabetes, baseline eGFR, tumor diagnosis, proteinuria, GS%, IFTA%, and AAS.

Results

The median follow-up time is 147d. In all patients, independent risk factors of post-nx decreased eGFR were female(p=0.02), age(p=0.01), overweight(p<0.001), eGFR<90 at the time of nephrectomy(p<0.001), severe AAS(p<0.01), and prolonged follow-up.
In the ones with baseline eGFR≥90(n=61), proteinuria(p<0.001) and BMI(p<0.001) were independent risk factors of post-nx decreased eGFR. For every 1 kg/m2 increase in BMI, there is a 3.3, 3.8, and 3.7ml/min/1.73m2 decline of eGFR at baseline, within 3 mo post-nx, and longer follow-up. For every 100mg/dl increase in urine protein, there is an 11.4, 17.3, and 19.5ml/min/1.73m2 decline of eGFR at baseline, within 3 mo post-nx, and longer follow-up.
In patients with baseline eGFR<90ml/min/1.73m2(n=126) longer follow-up, severe AAS(p=0.02), GS%>25%(p=0.02) and overweight (p=0.03) were independent risk factors of decreased post-nx eGFR. eGFR time trend of patients with and without these risk factors is shown in the figure.

Conclusion

We propose a minimum workup for this population to include eGFR,urinalysis, and non-neoplastic pathology evaluation. The time of kidney cancer treatment may be a unique opportunity for these patients to be identified and directed to early interventions, including nephrology consults and patient education on nutrition and weight control.