■缺乏关于两个肾脏且保留基线肾功能的患者的局部肾肿块(LRM)手术后急性肾损伤(AKI)和新发慢性肾病(CKD)的证据。
■评估单个肾脏肿块并在接受部分(PN)或根治性(RN)肾切除术后保留肾功能的患者中,AKI和新发临床显着CKD(csCKD)的患病率和风险。
■我们查询了我们前瞻性维护的数据库,以确定术前估计肾小球滤过率(eGFR)≥60ml/min/1.73m2和正常对侧肾脏的患者,这些患者在2015年1月至2021年12月期间在四家大型学术机构接受了一次LRM(cT1-T2N0M0)的PN或RN。
■PN或RN。
■这项研究的结果是出院时的AKI和新发CSCKD的风险,定义为eGFR<45ml/min/1.73m2,在随访期间。根据肿瘤的复杂性,使用Kaplan-Meier曲线检查无csCKD的生存率。多变量逻辑回归分析评估了AKI的预测因子,而多变量Cox回归分析评估了csCKD的预测因子。对接受PN的患者进行敏感性分析。
■总的来说,2469/3076(80%)患者符合纳入标准。出院时,371/2469(15%)发生AKI(8.7%vs14%vs31%在低、中、高复杂性肿瘤患者中,p<0.001)。在多变量分析中,身体质量指数,高血压病史,肿瘤复杂性,RN能显著预测AKI的发生。在1389(56%)有完整随访数据的患者中,记录了80例csCKD事件。估计无csCKD生存率为97%,在12、36和60个月时分别为93%和86%,分别,高复杂性和低复杂性以及高复杂性和中等复杂性肿瘤患者之间存在显着差异(分别为p=0.014和p=0.038)。在Cox回归分析中,年龄调整后的Charlson合并症指数,术前eGFR,肿瘤复杂性,RN在随访期间可显著预测CSCKD的风险。PN队列的结果相似。该研究的主要局限性是缺乏关于手术后1年内eGFR轨迹和长期功能结果的数据。
■在LRM和基线肾功能保留的择期患者中,AKI和从头CSCKD的风险在临床上不可忽略,尤其是那些复杂性较高的肿瘤。虽然基线不可改变的患者/肿瘤相关特征调节这种风险,如果肿瘤结局不受影响,PN应优先于RN,以最大程度地保留肾单位。
■在这项研究中,我们评估了有多少患有局部肾脏肿块和两个功能正常的肾脏的患者,他们是四个欧洲转诊中心的手术候选人,出院时出现急性肾损伤,随访期间出现显著肾功能损害.我们发现,急性肾损伤和临床意义慢性肾脏病患者人群的风险是不可忽视的,并与特定的基线患者合并症相关,术前肾功能,肿瘤解剖复杂性,和手术相关因素,尤其是根治性肾切除术的表现。
UNASSIGNED: There is a lack of evidence on acute kidney injury (AKI) and new-onset chronic kidney disease (CKD) after surgery for localised renal masses (LRMs) in patients with two kidneys and preserved baseline renal function.
UNASSIGNED: To evaluate the prevalence and risk of AKI and new-onset clinically significant CKD (csCKD) in patients with a single renal mass and preserved renal function after being treated with partial (PN) or radical (RN) nephrectomy.
UNASSIGNED: We queried our prospectively maintained databases to identify patients with a preoperative estimated glomerular filtration rate (eGFR) of ≥60 ml/min/1.73 m2 and a normal contralateral kidney who underwent PN or RN for a single LRM (cT1-T2N0M0) between January 2015 and December 2021 at four high-volume academic institutions.
UNASSIGNED: PN or RN.
UNASSIGNED: The outcomes of this
study were AKI at hospital discharge and the risk of new-onset csCKD, defined as eGFR <45 ml/min/1.73 m2, during the follow-up. Kaplan-Meier curves were used to examine csCKD-free survival according to tumour complexity. A Multivariable logistic regression analysis assessed the predictors of AKI, while a multivariable Cox regression analysis assessed the predictors of csCKD. Sensitivity analyses were performed in patients who underwent PN.
UNASSIGNED: Overall, 2469/3076 (80%) patients met the inclusion criteria. At hospital discharge, 371/2469 (15%) developed AKI (8.7% vs 14% vs 31% in patients with low- vs intermediate- vs high-complexity tumours, p < 0.001). At the multivariable analysis, body mass index, history of hypertension, tumour complexity, and RN significantly predicted the occurrence of AKI. Among 1389 (56%) patients with complete follow-up data, 80 events of csCKD were recorded. The estimated csCKD-free survival rates were 97%, 93% and 86% at 12, 36, and 60 mo, respectively, with significant differences between patients with high- versus low-complexity and high- versus intermediate-complexity tumours (p = 0.014 and p = 0.038, respectively). At the Cox regression analysis, age-adjusted Charlson Comorbidity Index, preoperative eGFR, tumour complexity, and RN significantly predicted the risk of csCKD during the follow-up. The results were similar in the PN cohort. The main limitation of the
study was the lack of data on eGFR trajectories within the 1st year after surgery and on long-term functional outcomes.
UNASSIGNED: The risk of AKI and de novo csCKD in elective patients with an LRM and preserved baseline renal function is not clinically negligible, especially in those with higher-complexity tumours. While baseline nonmodifiable patient/tumour-related characteristics modulate this risk, PN should be prioritised over RN to maximise nephron preservation if oncological outcomes are not jeopardised.
UNASSIGNED: In this
study, we evaluated how many patients with a localised renal mass and two functioning kidneys, who were candidates for surgery at four referral European centres, experienced acute kidney injury at hospital discharge and significant renal functional impairment during the follow-up. We found that the risk of acute kidney injury and clinically significant chronic kidney disease in this patient population is not negligible, and was associated with specific baseline patient comorbidities, preoperative renal function, tumour anatomical complexity, and surgery-related factors, in particular the performance of radical nephrectomy.