血清尿酸变异性增加根治性肾切除术后肾细胞癌患者术后慢性肾脏病的风险。

Serum uric acid variability increases the risk of postoperative chronic kidney disease in patients with renal cell carcinoma after radical nephrectomy.

机构信息

Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Clinical Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

Urol Oncol. 2021 Aug;39(8):500.e1-500.e7. doi: 10.1016/j.urolonc.2021.05.027. Epub 2021 Jun 27.

DOI:10.1016/j.urolonc.2021.05.027

PMID:34187751

Abstract

OBJECTIVE

Serum uric acid (SUA) level is associated with the progression of chronic kidney disease (CKD). However, little is known about the predictive value of SUA variability for postoperative CKD in patients with renal cell carcinoma after radical nephrectomy. We aimed to investigate the association of SUA variability with postoperative CKD in this population.

METHOD

85 patients with preoperative estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m were enrolled in this single-center retrospective study and followed up for at least 6 months. Intra-individual SUA variability was defined as the standard deviation (SD) of SUA and the patients were stratified into three groups according to the tertiles of SUA SD (the lower, middle and upper tertile). The association of SUA variability with postoperative CKD, defined as an eGFR<60 ml/min/1.73m, was analyzed by Cox proportional hazard models and Kaplan-Meier analyses.

RESULTS

After a median follow-up time of 24(10-43) months, 44(51.7%) patients developed postoperative CKD. Kaplan-Meier curves showed that patients in the lower tertile had a longer CKD-free survival time [median CKD-free survival time 74(52.2-95.8) months] than those in the middle tertile [38(19.2-56.8) months] and upper tertile [21(17.9-24.1) months] (overall generalized Wilcoxon test: P=0.001; lower vs middle tertile: P=0.001; lower vs upper tertile: P<0.001). Adjusted Cox analyses indicated that increasing SUA SD tertiles were associated with a higher risk of postoperative CKD independent of baseline SUA, mean SUA during follow-up and other confounding variables. Compared with patients in the lower tertile, the risk for developing CKD increased by 4.6-fold for patients in the middle tertile and 7.9-fold in the upper tertile, respectively.

CONCLUSION

Increasing SUA variability was associated with an increased risk of postoperative CKD in patients with renal cell carcinoma after radical nephrectomy.

摘要

目的

血清尿酸（SUA）水平与慢性肾脏病（CKD）的进展有关。然而，对于肾细胞癌根治性肾切除术后 SUA 变异性与术后 CKD 的预测价值知之甚少。我们旨在研究该人群中 SUA 变异性与术后 CKD 的关系。

方法

本单中心回顾性研究纳入了 85 例术前估算肾小球滤过率（eGFR）≥60ml/min/1.73m 的患者，并至少随访 6 个月。个体内 SUA 变异性定义为 SUA 的标准差（SD），根据 SUA SD 的三分位将患者分为三组（下、中、上三分位）。采用 Cox 比例风险模型和 Kaplan-Meier 分析 SUA 变异性与术后 CKD（定义为 eGFR<60ml/min/1.73m）的关系。

结果

中位随访时间为 24（10-43）个月后，44（51.7%）例患者发生术后 CKD。Kaplan-Meier 曲线显示，下三分位组患者的 CKD 无复发生存时间更长[中位 CKD 无复发生存时间 74（52.2-95.8）个月]，中三分位组[38（19.2-56.8）个月]和上三分位组[21（17.9-24.1）个月]（总体广义 Wilcoxon 检验：P=0.001；下三分位与中三分位：P=0.001；下三分位与上三分位：P<0.001）。调整后的 Cox 分析表明，SUA SD 三分位的增加与术后 CKD 的风险增加相关，与基线 SUA、随访期间的平均 SUA 及其他混杂变量无关。与下三分位组相比，中三分位组和上三分位组发生 CKD 的风险分别增加了 4.6 倍和 7.9 倍。