Renal Outcomes With Renin-Angiotensin System Blockers After Unilateral Nephrectomy

Despite the benefits of renin-angiotensin system (RAS) blockers, their immediate use after nephrectomy has been limited because of concerns about impaired renal adaptation. We aimed to evaluate the effect of RAS blockers immediately after unilateral nephrectomy on renal adaptation.

This single-center retrospective cohort study included 580 patients who underwent elective unilateral nephrectomy between 2010 and 2020 and had preexisting hypertension with antihypertensive medications. Patients were divided into groups according to the postnephrectomy RAS blocker use. The primary outcome was renal adaptation defined as (postnephrectomy estimated glomerular filtration rate [eGFR] ÷ prenephrectomy eGFR) × 100 at 1 month after surgery. Secondary outcomes included hyperkalemia during the first year and mortality or end-stage kidney disease within 3 years.

The mean age was 65.2 years, 406 (70%) were male, and 308 (53.1%) received RAS blockers after nephrectomy. The RAS blocker group was younger (63.8 vs. 66.8 years) and had a higher eGFR (79.4 vs. 75.5 ml/min per 1.73 m²) than the control group. There were no differences between the groups in renal adaptation at 1 month (67.1% vs. 66.8%; P = 0.711) or in the incidence of hyperkalemia until 1 year postoperatively. The RAS blocker use was associated with better dialysis-free survival (Adjusted hazard ratio of multivariable Cox-regression model: 0.531; 95% confidence interval: 0.329-0.857; P = 0.010].

The immediate use of RAS blockers after unilateral nephrectomy did not deteriorate renal adaptation or increase hyperkalemia. Furthermore, the RAS blockers were associated with improved prognosis in terms of end-stage kidney disease and mortality.