e16005 Background: Nephrectomy (Nx) is the standard of care for localized renal tumors. The risk of developing chronic renal insufficiency (CRI) increases after renal surgery. This study examines the functional outcomes for radical and partial Nx stratified by pre- and perioperative variables using estimated GFR. Methods: Using the Columbia Urologic Oncology Database, a retrospective analysis of patients treated with partial or radical Nx for renal cancer from 1988 to 2008 was conducted. Postoperative chronic renal function was measured using GFR as estimated by the MDRD study equation. Three primary outcomes were measured: 1) presence of new onset postoperative CRI (defined as GFR lower than 60 mL/min per 1.73 m2), 2) percent change in postoperative GFR from preoperative value, and 3) change in CRI stage postoperatively. Regression models were used to determine the effect of surgical procedure (radical vs partial Nx), approach, and multiple preoperative characteristics on functional outcomes. Results: 174 patients met the criteria for analysis after radical Nx and 102 after partial Nx for a total of 276 patients. 209 patients had preoperative GFR > 60, 67 had preoperative GFR < 60, and 6 had preoperative GFR < 30. After a minimum of 3 months postoperatively, 108/209 (52%) and 2/209 (1%) patients developed new-onset GFR <60 and <30, respectively. On multivariate analysis controlling for age, sex, race, diabetes and hypertension, preoperative CKD stage (p<0.001) and procedure (p<0.001) were both independent predictors of GFR progression to <60; similarly, preoperative CKD stage (p<0.001) and procedure (p<0.01) were independent predictors of percent change in postoperative GFR. Patient with worsened preoperative CRI stage were less likely to have further progression of CRI postoperatively (p<0.001) independent of the surgical procedure. Surgical approach was not an independent predictor of any renal functional outcomes measured. Conclusions: Patients undergoing renal surgery have a high rate of new-onset postoperative renal failure. After controlling for preoperative risk factors, patients undergoing radical Nx are at higher risk for decline in renal function. Surgical approach, however, was not a significant predictor for the development of CRI. No significant financial relationships to disclose.
Does size really matter? A retrospective analysis of donor renal volume and its effects on renal function in donors after donation