Open Access

ARTICLE

Postoperative risk of chronic kidney disease in radical nephrectomy and donor nephrectomy patients: a comparison and analysis of predictive factors

Fiona Mei Wen Wu¹, Melissa Hui Wen Tay¹, Zhaojin Chen², Bee Choo Tai^3,4, Lincoln Guan Lim Tan¹, Lata Raman¹, Ho Yee Tiong¹

1 Department of Urology, National University Health System, Singapore
2 Investigational Medicine Unit, National University Health System, Singapore
3 Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
4 Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
Address correspondence to Dr. Ho Yee Tiong, Department of Urology, National University Health System, NUHS Tower Block Level 8, 1E Kent Ridge Road, Singapore 119228

Canadian Journal of Urology 2014, 21(4), 7351-7357.

Abstract

Introduction: To compare baseline renal function and identify predictive factors in patients undergoing radical nephrectomy (RN) or donor nephrectomy (DN) and their risk of subsequent chronic kidney disease (CKD) after surgery.
Materials and methods: A retrospective review of patients with no baseline CKD undergoing RN (n = 88) and DN (n = 58) from 2000 to 2008 was performed. Baseline and postoperative renal function (eGFR) was determined using the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as eGFR < 60 mL/min/1.73 m² according to the National Kidney Foundation guidelines.
Results: Before surgery, patients undergoing RN and DN had a mean eGFR (± SD) of 83.5 ± 17.4 and 92.9 ± 17.0 mL/min/1.73 m² respectively (p = 0.002). Patients with RN had significantly greater morbidities including hypertension (47.7%), diabetes (14.8%) and ischemic heart disease (12.5%) than DN (5.2%, 0% and 1.7% respectively) (all p < 0.05). Median follow up was 3.5 years. The relative hazard of developing CKD post RN compared with DN was 1.91 (95% CI 1.01 to 3.61, p = 0.040). The median time to CKD was 77 months (range 2–107) for RN and 100 months (range 11–105) for DN. Age, gender, comorbidities, radical nephrectomy and baseline kidney function were individual risk factors for CKD post nephrectomy. However, preoperative eGFR was the only independent prognostic factor on multi-variable analysis.
Conclusions: Patients undergoing RN are distinctly different from kidney donors in terms of age, renal function and comorbidities. RN is not an independent predictive factor for CKD but the lower baseline renal function in RN patients significantly accelerates renal senescence in the uninephrectomy state.

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