Acute Kidney Injury Causes Chronic Kidney Disease Progression after Partial Nephrectomy: A Retrospective Study...

The aim of this study was to assess parameters predicting acute kidney injury (AKI) and chronic kidney disease progression (CKDP) after partial nephrectomy (PN).

The data of 785 patients were retrospectively reviewed. Follow-up eGFR was assessed in 542 patients. Patient characteristics, comorbidities, medication, and type of surgery were analyzed using group comparison and logistic regression.

Age (OR: 1.027 95% CI: 1.008-1.047; p = 0.006), male sex (OR: 2.128 95% CI: 1.506-3.007; p < 0.001), anemia (OR: 2.423 95% CI: 1.521-3.858; p < 0.001), CKD (OR: 1.742 95% CI: 1.084-2.800; p = 0.022), open PN (OR: 3.190 95% CI: 1.958-5.198; p < 0.001), ischemia (WIT) (OR: 1.049 95% CI: 1.027-1.072; p < 0.001), and surgery time (OR: 1.005 95% CI: 1.001-1.008; p = 0.008) were independent predictors of AKI. CKDP occurred in 224 (41.3%) patients, of whom 137 (61.2%) had experienced AKI (p < 0.001). Incidence increased with each AKI stage, which was the only independent predictor of CKDP (OR: 2.391 95% CI: 1.603-3.567; p < 0.001). Patient characteristics, approach, and WIT had no significant impact on CKDP.

AKI determines CKDP. Renal function loss increased at each AKI stage. We identified patients at risk for AKI, who could benefit from minimally invasive surgery and perioperative assessment in a team with nephrologists. As WIT did not influence CKDP, surgeons might consider prioritizing oncological outcomes, without compromising renal function through unnecessarily strict WIT limitations.