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International Journal of Urology (2014) 21, 613–616
doi: 10.1111/iju.12359
Short Communication
Better recovery of kidney function in patients with de novo chronic kidney disease after partial nephrectomy compared with those with pre-existing chronic kidney disease Toshio Takagi, Tsunenori Kondo, Junpei Iizuka, Kenji Omae, Hirohito Kobayashi, Yasunobu Hashimoto, Kazuhiko Yoshida and Kazunari Tanabe Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan
Abbreviations & Acronyms ASA score = American Society of Anesthesiologists score BMI = body mass index CKD = chronic kidney disease eGFR = estimated glomerular filtration rate IQR = interquartile range PN = partial nephrectomy RENAL-NS = R.E.N.A.L nephrometry score RN = radical nephrectomy Correspondence: Toshio Takagi M.D., Department of Urology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Email: [email protected] Received 8 July 2013; accepted 28 October 2013. Online publication 28 November 2013
Abstract: We compared kidney functional recovery between patients with pre-existing chronic kidney disease, those with de novo chronic kidney disease and those with normal kidney function, after partial nephrectomy. A total of 311 patients who underwent partial nephrectomy at Tokyo Women’s Medical University Hospital, Tokyo, Japan, between January 2004 and July 2011 with sufficient kidney functional data participated in the study. Patients with pre-existing chronic kidney disease (group1: 78 patients) were defined as those with estimated glomerular filtration rate under 60 mL/min/m2 before partial nephrectomy. Patients with de novo chronic kidney disease (group 2: 49) were defined as those with estimated glomerular filtration rate over 60 mL/min/m2 before surgery and who developed estimated glomerular filtration rate under 60 mL/min/m2 3 months after partial nephrectomy. Normal patients (group 3: 184) were defined as those with estimated glomerular filtration rate over 60 mL/min/m2 both before and after partial nephrectomy. Group 1 was associated with older age and higher comorbidity, including hypertension and diabetes mellitus, compared with other groups. R.E.N.A.L. score was not significantly different between the groups. Although the percent change of estimated glomerular filtration rate between the preoperative period and 3 months after partial nephrectomy in group 2 was significantly decreased compared with that in other groups (group 1: −6.8%, group 2: −18%, group 3: −7.3%), the renal functional recovery between 3 and 12 months after partial nephrectomy in group 2 was better than that in other groups (group 1: −0.5%, group 2: 5.6%, group 3: −0.4%). Patients with de novo chronic kidney disease had better kidney functional recovery than the other two groups, which might suggest that they were surgically assaulted and developed chronic kidney disease in the early postoperative period, and were essentially different from those with pre-existing chronic kidney disease.
Key words: chronic, kidney disease, kidney function, nephrectomy.
Introduction The major purpose of PN is to preserve renal function as much as possible and prevent the development of late-stage CKD. Renal function usually drops immediately after PN and recovers gradually to some extent.1–8 However, patients with preoperative CKD have correspondingly worse renal function after surgery, and an increased risk for complications and reduced overall survival compared with those without CKD.2 Recently, there has been an opinion that surgicallyinduced CKD is different from CKD as a result of medical causes. Actually, Brian et al. showed that surgically-induced CKD is associated with a relatively low risk of progressive renal functional decline and better survival rate compared with CKD as a result of medical causes in the setting of RN or PN.9 In the present study, we compared the differences in the functional recovery pattern of the kidney, and focused on PN between patients with pre-existing CKD, those with de novo CKD, and those with normal kidney function before and after PN.
Methods Patients An institutional review board-approved retrospective study was carried out for all patients, except those with a solitary kidney, a functional kidney on the contralateral side or insufficient © 2013 The Japanese Urological Association
613
T TAKAGI ET AL.
Table 1
Demographic and tumor data of patients
Variables
Entire cohort
Group 1 (pre-existing CKD)
Group 2 (de novo CKD)
Group 3 (normal eGFR)
P
Mean (median, IQR) or n (%) Patient specific factors Patients Age Sex Male Baseline eGFR (mL/min/1.72 m2) BMI (kg/m2) Hypertension Diabetes mellitus ASA score 2≥ 3≤ Pathology Malignant Tumor factors Tumor size (mm) RENAL-NS 4–6 7–9 10–12
311 58 (59, 49–67)
78 67 (67, 60–74)
49 58 (57, 51–67)
184 54 (55, 44–64)
International Journal of Urology (2014) 21, 613–616
doi: 10.1111/iju.12359
Short Communication
Better recovery of kidney function in patients with de novo chronic kidney disease after partial nephrectomy compared with those with pre-existing chronic kidney disease Toshio Takagi, Tsunenori Kondo, Junpei Iizuka, Kenji Omae, Hirohito Kobayashi, Yasunobu Hashimoto, Kazuhiko Yoshida and Kazunari Tanabe Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan
Abbreviations & Acronyms ASA score = American Society of Anesthesiologists score BMI = body mass index CKD = chronic kidney disease eGFR = estimated glomerular filtration rate IQR = interquartile range PN = partial nephrectomy RENAL-NS = R.E.N.A.L nephrometry score RN = radical nephrectomy Correspondence: Toshio Takagi M.D., Department of Urology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Email: [email protected] Received 8 July 2013; accepted 28 October 2013. Online publication 28 November 2013
Abstract: We compared kidney functional recovery between patients with pre-existing chronic kidney disease, those with de novo chronic kidney disease and those with normal kidney function, after partial nephrectomy. A total of 311 patients who underwent partial nephrectomy at Tokyo Women’s Medical University Hospital, Tokyo, Japan, between January 2004 and July 2011 with sufficient kidney functional data participated in the study. Patients with pre-existing chronic kidney disease (group1: 78 patients) were defined as those with estimated glomerular filtration rate under 60 mL/min/m2 before partial nephrectomy. Patients with de novo chronic kidney disease (group 2: 49) were defined as those with estimated glomerular filtration rate over 60 mL/min/m2 before surgery and who developed estimated glomerular filtration rate under 60 mL/min/m2 3 months after partial nephrectomy. Normal patients (group 3: 184) were defined as those with estimated glomerular filtration rate over 60 mL/min/m2 both before and after partial nephrectomy. Group 1 was associated with older age and higher comorbidity, including hypertension and diabetes mellitus, compared with other groups. R.E.N.A.L. score was not significantly different between the groups. Although the percent change of estimated glomerular filtration rate between the preoperative period and 3 months after partial nephrectomy in group 2 was significantly decreased compared with that in other groups (group 1: −6.8%, group 2: −18%, group 3: −7.3%), the renal functional recovery between 3 and 12 months after partial nephrectomy in group 2 was better than that in other groups (group 1: −0.5%, group 2: 5.6%, group 3: −0.4%). Patients with de novo chronic kidney disease had better kidney functional recovery than the other two groups, which might suggest that they were surgically assaulted and developed chronic kidney disease in the early postoperative period, and were essentially different from those with pre-existing chronic kidney disease.
Key words: chronic, kidney disease, kidney function, nephrectomy.
Introduction The major purpose of PN is to preserve renal function as much as possible and prevent the development of late-stage CKD. Renal function usually drops immediately after PN and recovers gradually to some extent.1–8 However, patients with preoperative CKD have correspondingly worse renal function after surgery, and an increased risk for complications and reduced overall survival compared with those without CKD.2 Recently, there has been an opinion that surgicallyinduced CKD is different from CKD as a result of medical causes. Actually, Brian et al. showed that surgically-induced CKD is associated with a relatively low risk of progressive renal functional decline and better survival rate compared with CKD as a result of medical causes in the setting of RN or PN.9 In the present study, we compared the differences in the functional recovery pattern of the kidney, and focused on PN between patients with pre-existing CKD, those with de novo CKD, and those with normal kidney function before and after PN.
Methods Patients An institutional review board-approved retrospective study was carried out for all patients, except those with a solitary kidney, a functional kidney on the contralateral side or insufficient © 2013 The Japanese Urological Association
613
T TAKAGI ET AL.
Table 1
Demographic and tumor data of patients
Variables
Entire cohort
Group 1 (pre-existing CKD)
Group 2 (de novo CKD)
Group 3 (normal eGFR)
P
Mean (median, IQR) or n (%) Patient specific factors Patients Age Sex Male Baseline eGFR (mL/min/1.72 m2) BMI (kg/m2) Hypertension Diabetes mellitus ASA score 2≥ 3≤ Pathology Malignant Tumor factors Tumor size (mm) RENAL-NS 4–6 7–9 10–12
311 58 (59, 49–67)
78 67 (67, 60–74)
49 58 (57, 51–67)
184 54 (55, 44–64)
