Significance of Glucose Control for Perioperative and Long-Term Renal Functions after Nephron-sparing Surgery for Renal Cancer in Patients with Diabetes
Urology Journal,
Vol. 20 No. 02 (2023),
27 February 2023
,
Page 116-122
https://doi.org/10.22037/uj.v20i02.7103
Abstract
Purpose: This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS).
Materials and Methods: The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5–1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to < 60 mL/min/1.73 m2.
Results: Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariable analyses revealed that female gender (95% confidence interval [CI]: 0.16–0.91, odds ratio [OR] = 0.39, P = 0.029), uncontrolled DM (95% CI: 1.05–6.60, OR = 2.63, P = 0.039), and intermediate NePhRO score (95% CI: 1.07–3.80, OR = 2.02, P = 0.03) were associated with perioperative AKI. In addition, old age (95% CI: 1.10–1.18, OR = 1.14, P < 0.001) and uncontrolled DM (95% CI: 1.84–11.4, OR = 4.57, P = 0.001) were associated with long-term CKD progression.
Conclusion: Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery.
- nephron-sparing surgery, risk factor, renal function
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References
Kang HW, Seo SP, Kim WT, et al. Trends in clinical, operative, and pathologic characteristics of surgically treated renal mass in a Korean center: A surgical series from 1988 through 2015. Investig Clin Urol. 2019;60:184-94.
Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2017;71:606-17.
Jimenez-Romero ME, Moreno-Cortes JC, Canelon-Castillo EY, Diez-Farto S, Santotoribio JD. Predictive Factors of Renal Function in Partial Laparoscopic Nephrectomy in Patients with a Kidney Tumor. Curr Urol. 2019;13:150-6.
Chapman D, Moore R, Klarenbach S, Braam B. Residual renal function after partial or radical nephrectomy for renal cell carcinoma. Can Urol Assoc J. 2010;4:337-43.
Reinstatler L, Klaassen Z, Barrett B, Terris MK, Moses KA. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy. Int Braz J Urol. 2015;41:697-704.
Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.
Erdem S, Boyuk A, Verep S, et al. Diabetes mellitus is the only independent predictor of both postoperative and long term renal functions in elective laparoscopic partial nephrectomy with limited or overextended warm ischemia. Turk J Urol. 2019;45:S13-S21.
Satasivam P, Reeves F, Rao K, et al. Patients with medical risk factors for chronic kidney disease are at increased risk of renal impairment despite the use of nephron-sparing surgery. BJU Int. 2015;116:590-5.
Hakky TS, Baumgarten AS, Allen B, et al. Zonal NePhRO scoring system: a superior renal tumor complexity classification model. Clin Genitourin Cancer. 2014;12:e13-8.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471-4.
American Diabetes A. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36 Suppl 1:S11-66.
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019;75:799-810.
Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS, Urologic Diseases in America P. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008;112:511-20.
Derweesh IH, Novick AC. Mechanisms of renal ischaemic injury and their clinical impact. BJU Int. 2005;95:948-50.
Porpiglia F, Renard J, Billia M, et al. Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One-year results of a prospective study. Eur Urol. 2007;52:1170-8.
Erdem S, Boyuk A, Tefik T, et al. Warm Ischemia-Related Postoperative Renal Dysfunction in Elective Laparoscopic Partial Nephrectomy Recovers During Intermediate-Term Follow-Up. J Endourol. 2015;29:1083-90.
Laven BA, Orvieto MA, Chuang MS, et al. Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model. J Urol. 2004;172:2471-4.
Dong W, Wu J, Suk-Ouichai C, et al. Ischemia and Functional Recovery from Partial Nephrectomy: Refined Perspectives. Eur Urol Focus. 2018;4:572-8.
Kriegmair MC, Mandel P, Moses A, Bolenz C, Michel MS, Pfalzgraf D. Zonal NephRo Score: external validation for predicting complications after open partial nephrectomy. World J Urol. 2016;34:545-51.
Hart PD, Bakris GL. Hypertensive nephropathy: prevention and treatment recommendations. Expert Opin Pharmacother. 2010;11:2675-86.
Vavallo A, Simone S, Lucarelli G, et al. Pre-existing type 2 diabetes mellitus is an independent risk factor for mortality and progression in patients with renal cell carcinoma. Medicine (Baltimore). 2014;93:e183.
Demirjian S, Lane BR, Derweesh IH, Takagi T, Fergany A, Campbell SC. Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival. J Urol. 2014;192:1057-62.
Shahwan M, Hassan N, Shaheen RA, et al. Diabetes Mellitus and Renal Function: Current Medical Research and Opinion. Curr Diabetes Rev. 2021;17:e011121190176.
O'Donnell K, Tourojman M, Tobert CM, et al. Proteinuria is a Predictor of Renal Functional Decline in Patients with Kidney Cancer. J Urol. 2016;196:658-63.
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