Fukushi Ken, Hatakeyama Shingo, Yamamoto Hayato, Tobisawa Yuki, Yoneyama Tohru, Soma Osamu, Matsumoto Teppei, Hamano Itsuto, Narita Takuma, Imai Atsushi, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Terayama Yuriko, Funyu Tomihisa, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
BMC Urol. 2017 Feb 6;17(1):13. doi: 10.1186/s12894-017-0202-x.
Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic kidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before surgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of renal function in patients undergoing radical nephrectomy.
Between January 1995 and December 2012, we performed 511 consecutive radical nephrectomies for patients with RCC. We retrospectively studied data from 109 patients who had regular postoperative follow-up of renal function for at least five years. The patients were divided into non-CKD and pre-CKD based on a preoperative estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m or <60 mL/min/1.73 m, respectively. The ACI was quantitatively measured by abdominal computed tomography before surgery. The patients in each group were stratified between low and high ACIs. Variables such as age, sex, comorbidities, and pre- and postoperative renal function were compared between patients with a low or high ACI in each group. Renal function deterioration-free interval rates were evaluated by Kaplan-Meier analysis. Factors independently associated with deterioration of renal function were determined using multivariate analysis.
The median age, preoperative eGFR, and ACI in this cohort were 65 years, 68 mL/min/1.73 m, and 8.3%, respectively. Higher ACI (≥8.3%) was significantly associated with eGFR decline in both non-CKD and pre-CKD groups. Renal function deterioration-free interval rates were significantly lower in the ACI-high than ACI-low strata in both of the non-CKD and pre-CKD groups. Multivariate analysis showed that higher ACI was an independent risk factor for deterioration of renal function at 5 years after radical nephrectomy.
Aortic calcification burden is a potential predictor of deterioration of renal function after radical nephrectomy.
This study was registered as a clinical trial: UMIN000023577.
肾细胞癌（RCC）根治性肾切除术是慢性肾脏病（CKD）发生的一个危险因素，术前必须考虑肾功能术后恶化的可能性。我们研究了主动脉钙化指数（ACI）对根治性肾切除术患者肾功能恶化预测的作用。
1995年1月至2012年12月期间，我们对511例RCC患者连续实施了根治性肾切除术。我们回顾性研究了109例术后至少进行了5年肾功能定期随访的患者的数据。根据术前估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m²或<60 mL/min/1.73 m²，将患者分为非CKD组和CKD前期组。术前通过腹部计算机断层扫描对ACI进行定量测量。每组患者按ACI高低分层。比较每组中ACI低或高的患者之间的年龄、性别、合并症以及术前和术后肾功能等变量。采用Kaplan-Meier分析评估无肾功能恶化间期率。使用多变量分析确定与肾功能恶化独立相关的因素。
该队列患者的中位年龄、术前eGFR和ACI分别为65岁、68 mL/min/1.73 m²和8.3%。在非CKD组和CKD前期组中，较高的ACI（≥8.3%）均与eGFR下降显著相关。在非CKD组和CKD前期组中，ACI高的分层的无肾功能恶化间期率均显著低于ACI低的分层。多变量分析显示，较高的ACI是根治性肾切除术后5年肾功能恶化的独立危险因素。
主动脉钙化负荷是根治性肾切除术后肾功能恶化的潜在预测指标。
本研究注册为一项临床试验：UMIN000023577。
