Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium).
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Tafuri Alessandro, Marchioni Michele, Cerrato Clara, Mari Andrea, Tellini Riccardo, Odorizzi Katia, Veccia Alessandro, Amparore Daniele, Shakir Aliasger, Carbonara Umberto, Panunzio Andrea, Trovato Federica, Catellani Michele, Janello Letizia M I, Bianchi Lorenzo, Novara Giacomo, Dal Moro Fabrizio, Schiavina Riccardo, De Lorenzis Elisa, Parma Paolo, Cimino Sebastiano, De Cobelli Ottavio, Maiorino Francesco, Bove Pierluigi, Crocerossa Fabio, Cantiello Francesco, D'Andrea David, Di Cosmo Federica, Porpiglia Francesco, Ditonno Pasquale, Montanari Emanuele, Soria Francesco, Gontero Paolo, Liguori Giovanni, Trombetta Carlo, Mantica Guglielmo, Borghesi Marco, Terrone Carlo, Del Giudice Francesco, Sciarra Alessandro, Galosi Andrea, Moschini Marco, Shariat Shahrokh F, Di Nicola Marta, Minervini Andrea, Ferro Matteo, Cerruto Maria Angela, Schips Luigi, Pagliarulo Vincenzo, Antonelli Alessandro
Аннотация
METHODS: Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR - baseline eGFR; Δ2 = 6 months eGFR - POD-1 eGFR; Δ3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up.
RESULTS: A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p < 0.001) during follow-up.
CONCLUSION: Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.