Chronic kidney disease after partial nephrectomy in patients with preoperative inconspicuous renal function – curiosity or relevant issue?

Abstract Background Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF). Patients & Methods Patients who underwent PN with a preoperative eGFR >60 ml/min/1.73m2 were retrospectively examined at 8 European urological centres. The occurrence of new onset CKD ≥ stage III after surgery (sCKD) was defined as primary endpoint. Group comparisons and risk correlations were determined. Based on this data a risk stratification model for sCKD was developed. Results Of the 1315 NPRF patients included, 249 (18.9%) developed sCKD after a median follow-up of 44 months (range: 6-255). Pair analysis and univariable regression revealed age, arterial hypertension, ASA score, tumour stage, surgical approach, intraoperative blood loss, perioperative blood transfusions and preoperative CKD stage as predictors for sCKD development. Multivariate analysis confirmed perioperative blood transfusion (HR=2.96; p≤0.0001), age (≥55 years; HR=2.60; p=0.0002), tumour stage (>pT1; HR=2.15; p=0.025), and preoperative CKD stage (stage II vs I; HR=3.85; p≤0.0001) as independent risk factors. A model which stratified patient risk for new onset CKD was highly significant (p Conclusion Every fifth patient with NPRF developed sCKD following PN. Elderly patients with higher tumour stage and who require blood transfusion appear to be at increased risk. Based on our risk stratification patients with ≥2 risk factors are candidates for an early, nephrological follow-up.