TY - JOUR
T1 - Adverse renal outcomes in subjects undergoing nephrectomy for renal tumors
T2 - A population-based analysis
AU - Klarenbach, Scott
AU - Moore, Ronald B.
AU - Chapman, David W.
AU - Dong, James
AU - Braam, Branko
N1 - Funding Information:
Funding/Support and role of the sponsor: This project was funded by an operating grant from the Northern Alberta Renal Program. The funder had no influence on the design, analysis, or drafting of the manuscript. Scott Klarenbach and Ronald Moore are supported by career salary awards from the Alberta Heritage Foundation for Medical Research/Alberta Innovates Health Solutions. Branko Braam is supported by a career salary award from the Heart and Stroke Foundation of Canada. Scott Klarenbach and Branko Braam are supported by a joint initiative between Alberta Health and Wellness and the University of Alberta. David Chapman was a recipient of a summer studentship from the Faculty of Medicine, University of Alberta.
PY - 2011/3
Y1 - 2011/3
N2 - Background: There has been increasing interest in determining renal outcomes after nephrectomy for renal tumors. Previous studies have not assessed all relevant risk factors, including proteinuria. Objective: We sought to determine the risk and predictors for the development of adverse renal outcomes in a population-based cohort of subjects undergoing partial or complete nephrectomy. Design, setting, and participants: A large population-based data set was used to identify all subjects undergoing nephrectomy in Alberta, Canada, from 2002 to 2007 using administrative codes. Comorbid conditions were determined using validated algorithms, and baseline estimated glomerular filtration rate (eGFR) and proteinuria status were determined. Measurements: Postsurgical outcomes of end-stage renal disease, acute dialysis, chronic kidney disease (CKD) (eGFR <30 ml/min per 1.73 m2), and rapidly progressive CKD (eGFR <60 ml/min per 1.73 m2 and eGFR loss ≥4 ml/min per 1.73 m2 per year) were assessed. The risk and risk factors for developing the composite renal outcome were determined using a multivariable Cox proportional hazards model. Results and limitations: Of 1151 subjects, 10.5% developed an adverse renal outcome over a mean of 32 mo. Complete (vs partial) nephrectomy was associated with a hazard ratio (HR) of 1.75 (95% confidence interval [CI], 1.02-2.99) for the primary outcome, as was lower baseline eGFR. Subjects with proteinuria were more likely to experience the primary outcome (42% vs 9%), conferring an adjusted HR of 2.40 (95% CI, 1.47-3.88). Conclusions: Clinically important adverse renal outcomes are common in patients undergoing nephrectomy for renal tumors. In addition to baseline eGFR and the extent of the renal mass removed, proteinuria is a strong independent risk factor. Assessment of proteinuria, in addition to other risk factors, should be performed to inform prognosis and the optimal treatment strategy.
AB - Background: There has been increasing interest in determining renal outcomes after nephrectomy for renal tumors. Previous studies have not assessed all relevant risk factors, including proteinuria. Objective: We sought to determine the risk and predictors for the development of adverse renal outcomes in a population-based cohort of subjects undergoing partial or complete nephrectomy. Design, setting, and participants: A large population-based data set was used to identify all subjects undergoing nephrectomy in Alberta, Canada, from 2002 to 2007 using administrative codes. Comorbid conditions were determined using validated algorithms, and baseline estimated glomerular filtration rate (eGFR) and proteinuria status were determined. Measurements: Postsurgical outcomes of end-stage renal disease, acute dialysis, chronic kidney disease (CKD) (eGFR <30 ml/min per 1.73 m2), and rapidly progressive CKD (eGFR <60 ml/min per 1.73 m2 and eGFR loss ≥4 ml/min per 1.73 m2 per year) were assessed. The risk and risk factors for developing the composite renal outcome were determined using a multivariable Cox proportional hazards model. Results and limitations: Of 1151 subjects, 10.5% developed an adverse renal outcome over a mean of 32 mo. Complete (vs partial) nephrectomy was associated with a hazard ratio (HR) of 1.75 (95% confidence interval [CI], 1.02-2.99) for the primary outcome, as was lower baseline eGFR. Subjects with proteinuria were more likely to experience the primary outcome (42% vs 9%), conferring an adjusted HR of 2.40 (95% CI, 1.47-3.88). Conclusions: Clinically important adverse renal outcomes are common in patients undergoing nephrectomy for renal tumors. In addition to baseline eGFR and the extent of the renal mass removed, proteinuria is a strong independent risk factor. Assessment of proteinuria, in addition to other risk factors, should be performed to inform prognosis and the optimal treatment strategy.
KW - Carcinoma, renal cell
KW - Chronic kidney disease
KW - End-stage renal disease
KW - Nephrectomy
KW - Proportional hazards models
KW - Proteinuria
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U2 - 10.1016/j.eururo.2010.11.013
DO - 10.1016/j.eururo.2010.11.013
M3 - Article
C2 - 21109345
AN - SCOPUS:79551501499
SN - 0302-2838
VL - 59
SP - 333
EP - 339
JO - European Urology
JF - European Urology
IS - 3
ER -