Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma Journal Article

Authors: Kaag, M.; Trost, L.; Thompson, R. H.; Favaretto, R.; Elliott, V.; Shariat, S. F.; Maschino, A.; Vertosick, E.; Raman, J. D.; Dalbagni, G.
Article Title: Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma
Abstract: Objectives: To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To identify predictors of renal function decline after surgery, thereby allowing the identification of patients likely to be ineligible for cisplatin-based chemotherapy in the adjuvant setting. Patients and Methods: We retrospectively identified 374 patients treated with RNU for UTUC at three centres between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation before RNU and at early (1-5 months after RNU) and late (>5 months) time points after RNU. Only patients deemed eligible for cisplatin-based chemotherapy before RNU (preoperative glomerular filtration rate [GFR] 60mL/min/1.73m(2)) were included. Multivariable analysis identified the preoperative predictors of eGFR after RNU at early postoperative and late postoperative time points. Results: A total of 163 patients had an eligible early post-RNU eGFR measurement and 172 had an eligible late eGFR measurement. The median eGFR declined by 32% and did not show a significant trend toward recovery over time (P = 0.4). On multivariable analysis preoperative eGFR and patient age were significantly associated with early and late postoperative eGFR, while Charlson comorbidity index score was significantly associated with late postoperative eGFR alone. Conclusions: In patients with normal preoperative eGFR (60mL/min/1.73m(2)), renal function decreases by one-third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre-RNU eGFR closer to 60mL/min/1.73m(2) (lower eGFR in the present cohort) are more likely to be ineligible for adjuvant cisplatin-based chemotherapy regimens because of renal function loss after RNU.
Keywords: chemotherapy; pelvis; risk; kidney; chronic kidney disease; urothelial carcinoma; nephroureterectomy; grade; transitional cell carcinoma; outcomes; neoadjuvant; transitional-cell carcinoma; upper urinary-tract; bladder-cancer; disease; ureteroscopic biopsy
Journal Title: BJU International
Volume: 114
Issue: 5
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2014-11-01
Start Page: 674
End Page: 679
Language: English
ACCESSION: WOS:000344254100012
DOI: 10.1111/bju.12597
PUBMED: 24314050
Notes: Article -- Source: Wos
Citation Impact
MSK Authors
  1. Guido Dalbagni
    272 Dalbagni