Incidence, risk factors, and significance of 20% decrease from new baseline estimated glomerular filtration rate...

Area of Science:

• Nephrology
• Urology
• Oncology

Background:

• Radical nephrectomy (RN) and partial nephrectomy (PN) are common treatments for renal cancer.
• Post-surgical kidney function decline, particularly a 20% decrease in new baseline estimated glomerular filtration rate (NB-eGFR), is a concern.
• Understanding the incidence and risk factors of this decline is crucial for patient management.

Purpose of the Study:

• To determine the incidence and risk factors for a 20% NB-eGFR decrease within two years post-nephrectomy (RN or PN).
• To compare the incidence of end-stage renal disease (ESRD) in patients with and without this eGFR decrease.
• To assess if surgical approach (RN vs. PN) influences the risk of eGFR decline and ESRD.

Main Methods:

• Retrospective analysis of 238 RN and 369 PN patients with cT1a-cT3a renal cancer.
• Multivariate logistic regression used to identify risk factors for a 20% NB-eGFR decrease.
• ESRD development was analyzed as a primary endpoint, comparing incidence based on the presence or absence of eGFR decline.

Main Results:

• A 20% NB-eGFR decrease occurred in 6.1% of patients (4.2% after RN, 7.3% after PN) within two years.
• Independent risk factors included diabetes mellitus, proteinuria, and perioperative complications; surgical type was not significant.
• Six-year ESRD-free survival was significantly lower in patients with the eGFR decrease (75.5%) compared to those without (99.6%).

Conclusions:

• The 20% NB-eGFR decrease is a significant predictor of future ESRD, with a 24.5% incidence at six years.
• Patients experiencing this eGFR decline warrant meticulous follow-up and renal function monitoring.
• Surgical approach (RN vs. PN) did not significantly impact ESRD-free survival.