Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)
Alessandro Tafuri, Michele Marchioni, Clara Cerrato, Andrea Mari, R. Tellini, Katia Odorizzi, Alessandro Veccia, Daniele Amparore, Aliasger Shakir, Umberto Carbonara, Andrea Panunzio, Federica Trovato, Michele Catellani, Letizia M. I. Janello, Lorenzo Bianchi, Giacomo Novara, Fabrizio Moro, Riccardo Schiavina, E. De Lorenzis, Paolo Parma, Sebastiano Cimino, Ottavio De Cobelli, Francesco Maiorino, Pierluigi Bove, Fabio Crocerossa, Francesco Cantiello, David D’Andrea, Federica Di Cosmo, Francesco Porpiglia, Pasquale Ditonno, E. Montanari, Francesco Soria, Paolo Gontero, Giovanni Liguori, Carlo Trombetta, Guglielmo Mantica, Marco Borghesi, Carlo Terrone, Francesco Del Giudice, Alessandro Sciarra, Andrea Benedetto Galosi, Marco Moschini, Shahrokh F. Shariat, Marta Di Nicola, Andrea Minervini, Matteo Ferro, Maria Angela Cerruto, Luigi Schips, Vincenzo Pagliarulo, Alessandro Antonelli
Abstract
PURPOSE: To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS: Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR - baseline eGFR; Δ2 = 6 months eGFR - POD-1 eGFR; Δ3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. RESULTS: A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p < 0.001) during follow-up. CONCLUSION: Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.