Yu Seong Hyeon, Eun Seong Jong, Kang Taek Won
Department of Urology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
Urol J. 2023 Feb 27;20(2):116-122. doi: 10.22037/uj.v19i.7103.
This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS).
The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5-1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to < 60 mL/min/1.73 m2.
Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariable analyses revealed that female gender (95% confidence interval [CI]: 0.16-0.91, odds ratio [OR] = 0.39, P = 0.029), uncontrolled DM (95% CI: 1.05-6.60, OR = 2.63, P = 0.039), and intermediate NePhRO score (95% CI: 1.07-3.80, OR = 2.02, P = 0.03) were associated with perioperative AKI. In addition, old age (95% CI: 1.10-1.18, OR = 1.14, P < 0.001) and uncontrolled DM (95% CI: 1.84-11.4, OR = 4.57, P = 0.001) were associated with long-term CKD progression.
Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery.
本研究旨在评估保留肾单位手术（NSS）后围手术期及长期肾功能的预测因素。
回顾性分析2009年至2016年间379例因单侧肾肿瘤行NSS且对侧肾脏正常的患者的临床记录。术后，使用血清肌酐（S-Cr）水平评估术后7天内急性肾损伤（AKI）的发生情况以及5年后慢性肾脏病（CKD）的进展情况。围手术期AKI定义为S-Cr水平升高≥0.3mg/dL或为基线值的1.5 - 1.9倍。CKD定义为估计肾小球滤过率（eGFR）从>60mL/min/1.73m²降至<60mL/min/1.73m²。
术后5年内评估了eGFR的变化。379例患者中，81例（21.4%）患有糖尿病（DM），30例（7.92%）患有未控制的DM。分别有50例（13.2%）患者发生AKI，79例（20.8%）患者出现CKD进展。多变量分析显示，女性（95%置信区间[CI]：0.16 - 0.91，优势比[OR]=0.39，P = 0.029）、未控制的DM（95%CI：1.05 - 6.60，OR = 2.63，P = 0.039）和中等NePhRO评分（95%CI：1.07 - 3.80，OR = 2.02，P = 0.03）与围手术期AKI相关。此外，老年（95%CI：1.10 - 1.18，OR = 1.14，P < 0.001）和未控制的DM（95%CI：1.84 - 11.4，OR = 4.57，P = 0.001）与长期CKD进展相关。
未控制的DM是保留肾单位手术后围手术期及长期肾功能的唯一预测因素。
