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

G. Verhoest, J. J. Patard, E. Oger, N. Rioux-Leclercq, Benoit Peyronnet, T. Bessède, P. Laguna, K. Barwari, J. Rigaud, M. Roupret, G. Coffin, J. C. Bernhard, J. A. Long, A. Zisman, J. Berger, P. Paparel, C. Maurin, E. Lechevallier, R. Bertini, I. OuzaidL. Salomon, A. Bex, R. Farfara, B. Ljungberg, A. R. Rodriguez, K. Bensalah

Research output: Contribution to journalArticle

Abstract

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 MDRD2, respectively. Most of the patients (65%) were male with an anatomic solitary 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. ml/min, p 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.

Original languageEnglish
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 2014

Keywords

  • Conservative surgery
  • Kidney cancer
  • Renal cell carcinoma
  • Renal failure

ASJC Scopus subject areas

  • Oncology
  • Urology

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    Verhoest, G., Patard, J. J., Oger, E., Rioux-Leclercq, N., Peyronnet, B., Bessède, T., Laguna, P., Barwari, K., Rigaud, J., Roupret, M., Coffin, G., Bernhard, J. C., Long, J. A., Zisman, A., Berger, J., Paparel, P., Maurin, C., Lechevallier, E., Bertini, R., ... Bensalah, K. (2014). Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: A multi-institutional study. Urologic Oncology: Seminars and Original Investigations, 32(1). https://doi.org/10.1016/j.urolonc.2012.10.003