The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma

Background: Radical nephrectomy (RN) is the standard treatment for localized renal cell carcinoma. The decrease of nephrons by the RN could lead to postoperative chronic kidney disease(CKD). The study aims to investigate the incidence and risk factors of CKD in patients who had received RN. Methods: : A Total of 1233 patients were diagnosed with renal cell carcinoma and underwent radical nephrectomy in Zhejiang Provincial People’s Hospital from January 2010 to December 2018. Those who had abnormal renal function before surgery or lost to follow-up were excluded. 500 patients were enrolled in the end. eGFR was calculated using the abbreviated MDRD equation. CKD was defined as eGFR less than 60 ml/min/1.73m 2 . Incidence of postoperative CKD was estimated using the Kaplan-Meier method. The independent risk factors of the occurrence of CKD was determined through logistic multivariate regression analysis. Results: Patients were followed up for a median of 40 month (3-96 months), with CKD occurred in 189 cases. 5-year cumulative incidence of CKD was 43.4%. There was a significant difference between these 189 patients and the rest patients without post nephrectomy CKD in terms of age, sex, weight, preoperative eGFR(P＜0.05). Multivariate regression analysis shows that age (OR=1.038, 95%CI=1.002-1.076), preoperative eGFR of the contralateral kidney (OR=0.934, 95%CI=0.884-0.988) and postoperative eGFR (OR=0.892, 95%CI=0.854-0.931) were independent risk factors for postoperative CKD. Conclusions: : The incidence of CKD after radical nephrectomy was not uncommon. Age, preoperative eGFR of the contralateral kidney and postoperative eGFR are independent risk factors for postoperative CKD.