Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: a multi-institutional study

被引：11

作者：

Verhoest, G. ^{[1
]}

Patard, J. J. ^{[1
]}

Oger, E. ^{[1
]}

Rioux-Leclercq, N. ^{[1
]}

Peyronnet, Benoit ^{[1
]}

Bessede, T. ^{[1
]}

Laguna, P. ^{[1
]}

Barwari, K. ^{[1
]}

Rigaud, J. ^{[1
]}

Roupret, M. ^{[1
]}

Coffin, G. ^{[1
]}

Bernhard, J. C. ^{[1
]}

Long, J. A. ^{[1
]}

Zisman, A. ^{[1
]}

Berger, J. ^{[1
]}

Paparel, P. ^{[1
]}

Maurin, C. ^{[1
]}

Lechevallier, E. ^{[1
]}

Bertini, R. ^{[1
]}

Ouzaid, I. ^{[1
]}

Salomon, L. ^{[1
]}

Bex, A. ^{[1
]}

Farfara, R. ^{[1
]}

Ljungberg, B. ^{[1
]}

Rodriguez, A. R. ^{[1
]}

Bensalah, K. ^{[1
]}

机构：

[1] Rennes Univ Hosp, Dept Urol, F-35033 Rennes, France

来源：

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS | 2014年 / 32卷 / 01期

关键词：

Renal cell carcinoma; Conservative surgery; Kidney cancer; Renal failure; NEPHRON SPARING SURGERY; SMALL RENAL MASSES; WARM ISCHEMIA; SURVIVAL; DIALYSIS; NOMOGRAM; RISKS; DEATH;

D O I：

10.1016/j.urolonc.2012.10.003

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Objective: Partial Nephrectomy (PN) in a solitary kidney is at risk of chronic kidney disease (CKD) stage V and/or haemodialysis (HD). Our objective was to determine predictive factors of CKD stage V in this population. Material & Methods: Data from 300 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics and renal function before surgery were analyzed. Patients with and without CKD stage V (defined as MDRD <15 nd/min) were compared using chi(2) and Student-t tests for qualitative and quantitative variables, respectively. Predictive factors of CKD stage V were evaluated with a multivariable analysis using a Cox regression model. Results: Median age and BMI were 63 years old and 26 kg/m(2), respectively. Most of the patients (65%) were male with an anatomic solitaly kidney (88.3%). Median tumor size was 4 cm and 98% were malignant tumors. Median operative time, blood loss and clamping time were 180 min, 350 ml and 20 min respectively. Renal cooling was used in 19.3% and clamping of the pedicle was performed in 61.6%. Twenty five patients (8.5%) presented post operative CKD stage V at last follow-up and 18 underwent HD (6%) post-operatively because of acute renal insufficiency. There was no difference between CKD stage V and non CKD stage V patients concerning Charlson index, operative time (180 min vs 179 min, p = 0.39), blood loss (475 ml vs 350 ml. p = 0.51), use of renal cooling and type of clamping. Patients with CKD stage V were older (70 vs 63 years old, p = 0.005), had a lower baseline renal function (clearance MDRD 41 vs. 62 mllmin, p < 0.0001) and an increased tumor size (p = 0.02). Complications occurred in 91 patients (30%) with 16% of minor (Clavien 1-2) and 14% of major (Clavien > 2) complications, respectively. In multivariable analysis, baseline MDRD. BMI, and the occurrence of a minor complication were independent predictive factors of post operative CKD stage V. Conclusion: PN in a solitary kidney is at risk of post-operative CKD stage V and HD. Pre-operative altered renal function and post operative complications are the main predictive factors of permanent CKD stage V. (C) 2014 Elsevier Inc. All rights reserved.

引用

页码：28.e21 / 28.e26

页数：6

共 21 条

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