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Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma.

Abstract：

OBJECTIVES:To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To identify predictors of renal function decline after surgery, thereby allowing the identification of patients likely to be ineligible for cisplatin-based chemotherapy in the adjuvant setting. PATIENTS AND METHODS:We retrospectively identified 374 patients treated with RNU for UTUC at three centres between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation before RNU and at early (1-5 months after RNU) and late (>5 months) time points after RNU. Only patients deemed eligible for cisplatin-based chemotherapy before RNU (preoperative glomerular filtration rate [GFR] ≥60 mL/min/1.73 m(2) ) were included. Multivariable analysis identified the preoperative predictors of eGFR after RNU at early postoperative and late postoperative time points. RESULTS:A total of 163 patients had an eligible early post-RNU eGFR measurement and 172 had an eligible late eGFR measurement. The median eGFR declined by 32% and did not show a significant trend toward recovery over time (P = 0.4). On multivariable analysis preoperative eGFR and patient age were significantly associated with early and late postoperative eGFR, while Charlson comorbidity index score was significantly associated with late postoperative eGFR alone. CONCLUSIONS:In patients with normal preoperative eGFR (≥60 mL/min/1.73 m(2) ), renal function decreases by one-third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre-RNU eGFR closer to 60 mL/min/1.73 m(2) (lower eGFR in the present cohort) are more likely to be ineligible for adjuvant cisplatin-based chemotherapy regimens because of renal function loss after RNU.

journal_name

BJU Int

journal_title

BJU international

authors

Kaag M,Trost L,Thompson RH,Favaretto R,Elliott V,Shariat SF,Maschino A,Vertosick E,Raman JD,Dalbagni G

doi

10.1111/bju.12597

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

674-9

issue

eissn

1464-4096

issn

1464-410X

journal_volume

114

pub_type

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Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma.