Premium
Impact of renal surgery for cortical neoplasms on lipid metabolism
Author(s) -
Bagrodia Aditya,
Kopp Ryan P.,
Mehrazin Reza,
Lee Hak J.,
Liss Michael A.,
Jabaji Ramzi,
Kane Christopher J.,
Wake Robert W.,
Patterson Anthony L.,
Wan Jim Y.,
Derweesh Ithaar H.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12744
Subject(s) - medicine , kidney disease , nephrectomy , renal function , demographics , incidence (geometry) , retrospective cohort study , urology , kidney , surgery , gastroenterology , endocrinology , physics , demography , sociology , optics
Objective To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy ( RN ) or partial nephrectomy ( PN ) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease ( CKD ). Patients and Methods We conducted a two‐centre retrospective analysis of 905 patients (mean age 57.5 years, mean follow‐up 78 months), who underwent RN ( n = 610) or PN ( n = 295) between J uly 1987 and J une 2007. Demographics, preoperative and postoperative hyperlipidaemia were recorded. De novo hyperlipidaemia was defined as that ocurring ≥6 months after surgery in cases where laboratory values met N ational C holesterol E ducation P rogram A dult T reatment P anel III definitions. The K aplan– M eier method was used to assess freedom from de novo hyperlipidaemia. Multivariable analysis was conducted to determine the risk factors for de novo hyperlipidaemia. Results There were no significant differences with respect to demographics, preoperative glomerular filtration rate ( GFR ) <60 mL/min/1.73 m 2 ( P = 0.123) and hyperlipidaemia ( P = 0.144). Tumour size (cm) was significantly larger in the RN group vs the PN group (7.0 vs 3.7; P < 0.001). Significantly greater postoperative GFR <60 mL/min/1.73 m 2 was noted in the RN group (45.7 vs 18%, P < 0.001). Significantly, more de novo hyperlipidaemia developed in the RN group than in the PN group (23 vs 6.4%; P < 0.001). The mean time to development of hyperlipidaemia was longer for PN than for RN (54 vs 44 months; P = 0.03). Five‐year freedom from de novo hyperlipidaemia probability was 76% for RN vs 96% for PN ( P < 0.001). Multivariable analysis showed that RN (odds ratio [ OR ] 2.93; P = 0.0107), preoperative GFR <60 mL/min/1.73 m 2 ( OR 1.98; P = 0.037) and postoperative GFR <60 mL/min/1.73 m 2 ( OR 7.89; P < 0.001) were factors associated with hyperlipidaemia development. Conclusion Patients who underwent RN had a significantly higher incidence of and shorter time to development of de novo hyperlipidaemia. RN and pre‐ and postoperative eGFR <60 mL/min/1.73 m 2 were associated with development of hyperlipidaemia. Further follow‐up and prospective investigation are necessary to confirm these findings.