Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction-Tumour Nephrectomy Database study

Background: To identify factors associated with acutely elevated serum creatinine (SCr) within 7 days of radical tumour nephrectomy. Methods: The study population consisted of 130 consecutive patients managed for renal tumours. The primary outcome was acute kidney injury (AKI) (defined as SCr increase >= 50% above baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase, assessed using multivariable linear regression analysis. Results: Following nephrectomy, the mean percentage increase in SCr in the first week was 55%+/- 29%, and 77 (59%) patients experienced AKI. Independent predictors of AKI post-nephrectomy were male gender [ adjusted odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.01, 6.93], urine albumin-creatinine ratio (OR: 0.66; 95% CI: 0.47, 0.91), preoperative estimated glomerular filtration rate (eGFR) (OR: 1.03; 95% CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95% CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (RCC) (OR: 2.93; 95% CI: 1.04, 8.29). Independent predictors of a SCr increase were male gender (beta: 12.0; 95% CI: 2.69, 21.3), urine albumin-creatinine ratio (beta: -3.36; 95% CI: -6.55, -0.16), preoperative eGFR (beta: 0.38; 95% CI: 0.10, 0.66), laparoscopic nephrectomy (beta: 12.7; 95% CI: 1.05, 24.3) and obesity (beta: 9.94, 95% CI: 0.61, 19.3). Conclusions: Male gender, albuminuria, eGFR and laparoscopic nephrectomy independently associated with acutely elevated serum creatinine following radical tumour nephrectomy.