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Postoperative complications increase the risk of long‐term chronic kidney disease after nephron‐sparing surgery in patients with renal cancer and normal preoperative renal function
Author(s) -
Ventimiglia Eugenio,
Larcher Alessandro,
Trevisani Francesco,
Muttin Fabio,
Cianflone Francesco,
Montorsi Francesco,
Salonia Andrea,
Bertini Roberto,
Capitanio Umberto
Publication year - 2019
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.14712
Subject(s) - medicine , renal function , kidney disease , hazard ratio , interquartile range , comorbidity , surgery , proportional hazards model , confounding , nephrectomy , confidence interval , urology , kidney
Objectives To investigate whether postoperative complications affect long‐term functional outcomes of renal patients treated with nephron‐sparing surgery (NSS). Materials and Methods We performed an observational study, enrolling 596 patients with preoperative normal renal function treated with NSS for clinical T1abN0M0 renal masses. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for chronic kidney disease (CKD) including as covariates age, comorbidity (scored according to the Charlson comorbidity index), hypertension, tumour size, preoperative estimated glomerular filtration rate (eGFR), eGFR < 60 mL/min/1.73 m 2 at discharge, and ischaemia time. Results A total of 137 patients (23%) developed postoperative complications. At a median (interquartile range) follow‐up of 53 (26–91) months, CKD risk was 19% for patients with postoperative complications and 11% for those without complications. Patients experiencing postoperative complications (HR 1.90, 95% CI 1.26–2.86) were at increased risk of developing CKD during the follow‐up at multivariable analysis, after accounting for confounders. Conclusions Our data outline how postoperative complications might have a detrimental impact on postoperative renal function in patients submitted to NSS. Improper patient selection, increasing the risk of postoperative complications, could limit the benefit in terms of renal function brought by NSS.