PURPOSE

To develop nomograms to predict the risks for postoperative acute kidney injury (PO-AKI) and chronic kidney disease (CKD) in patients with renal cell carcinoma and venous tumor thrombus (RCC-VTT).

METHODS

Consecutive postoperative patients with RCC-VTT (n = 353) were enrolled between January 2006 and June 2023. Clinicopathological, operative, and functional outcome data were analyzed. Logistic regression was used to develop predictive models incorporating risk factors. Model performance was assessed using the area under the curve (AUC), calibration, and decision curve analyses.

RESULTS

Among the 353 patients, the incidence of PO-AKI was 61.5%, with Stage 2-3 PO-AKI in 15.0% overall, 4.0% of cases with RCC and renal venous tumor thrombus, and 21.1% of RCC with inferior vena cava (IVC) tumor thrombus. Independent risk factors for PO-AKI included age > 60 years, male sex, contralateral renal artery and IVC clamping times > 20 min, BMI, and preoperative estimated glomerular filtration rate (eGFR). Tumor size was the only independent protective factor against PO-AKI. Of 297 patients, 83 (27.9%) developed CKD, with BMI > 24 kg/m, age > 60 years, hypertension, IVC cavectomy, PO-AKI, and adjuvant therapy representing independent risk factors, preoperative eGFR was the only independent protective factor. The AUCs for PO-AKI and CKD predictive models were 0.762 (95% confidence interval (CI): 0.712-0.812) and 0.863 (95% CI: 0.817-0.908), respectively, demonstrating good calibration and predictive accuracy.

CONCLUSION

The developed nomograms effectively predicted PO-AKI and CKD risks in patients with RCC-VTT, aiding in clinical decision-making and optimizing patient management to improve functional outcomes.