Trends and predictors of changes in renal function after radical nephrecto my for renal tumors

Trends and predictors of changes in renal function after radical nephrecto my for renal tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends and predictors of changes in renal function after radical nephrecto my for renal tumors Yongchao Yan, Xinning Wang, Yunbo Liu, Bin Li, Shang Xu, Haotian Du, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3988482/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Chronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation. Objective: This study aimed to investigate the trends in renal function changes and risk factors for renal function deterioration in patients with renal tumours after radical nephrectomy. Results: We analysed the data from 329 patients with renal tumours undergoing radical nephrectomies between January 2013 and December 2018. We monitored the changes in the patient’s renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression. In this study, 43.7% of patients had postoperative acute kidney injury (AKI) and 48.3% had upgraded CKD stages. Further research revealed that the patient’s renal function levelled off 3 months following surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function in patients. Conclusion: AKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy. renal function short term changes long-term prognosis AKI CKD Figures Figure 1 Figure 2 key learning points 1.After unilateral nephrectomy, 48.3% of the patients had an increase in CKD grade. 2.The changes of short-term renal function have an important impact on the prognosis of long-term renal function. 3.We should monitor and intervene the short-term renal function of patients with unilateral nephrectomy, so as to prevent the poor prognosis of long-term renal function. Introduction Currently, radical nephrectomy is the most common treatment for malignant renal tumours [1]. Removal of the kidney inevitably reduces the functional renal parenchyma, resulting in loss of renal function [2]. Previous studies have demonstrated that older age, high comorbidity rates, and low preoperative estimated glomerular filtration rate (eGFR) are associated with chronic kidney disease (CKD) after radical nephrectomy [3, 4]. Postoperative CKD in patients undergoing radical nephrectomy is associated with an increased risk of all-cause and cardiovascular disease-related mortality [5]. Previous studies have demonstrated that CKD results in increased proteinuria and blood pressure, which are associated with an increased risk of cardiovascular disease and all-cause mortality in the general population [6]. Observing and recording changes in patients’ eGFR after radical nephrectomy is crucial, and early measures should be taken to prevent CKD. Moreover, this can help improve our understanding of the changes in the renal function in patients after surgery and explore the indicators related to renal function progression. Therefore, the present study aimed to examine the trends in renal function changes and identify risk factors for renal function deterioration in patients with renal tumours after radical nephrectomy. Furthermore, key nodes of renal function changes were also identified. Materials and Methods 2.1. Patient Selection This single-centre retrospective observational study was approved by the Institutional Review Board (IRB) of The Affiliated Hospital of Qingdao University. The requirement for written informed consent was waived by the IRB board owing to the retrospective nature of the study. Using the scientific research big data platform of our hospital, we screened patients who underwent unilateral nephrectomy for renal tumours between 2013 and 2018. To ensure the completeness of the data, 329 patients were screened according to their postoperative follow-up compliance. Table 1. Demographic and baseline characteristics of the patients Variables Patients Age, year Female, n Hypertension, n Diabetes mellitus, n Preoperative eGFR, mL/min/1.73 m2 eGFR ≥ 90 mL/min/1.73m2 eGFR ＜90 mL/min/1.73m2 BMI,Kg/m 2 Tumor size，cm Clinical stage, n T1a T1b T2a T2b the ratio of postoperative creatinine to preoperative creatinine AKI,n Upgrading CKD staging,24 months,n 58(51-65) 118(35.8) 132(40.1) 43(13.0) 122(37.1) 207(62.9) 25.22±5.49 5.98±2.68 129(39.2) 128(38.9) 50(15.1) 22(6.6) 1.33±0.36 144(43.7) 159(48.3) AKI = acute kidney injury; eGFR = estimated glomerular filtration rate; BMI= Body Mass Index 2.2. Patient Data and Outcome Measurements Demographic and baseline characteristics of the patients related to renal function and procedure-related data were obtained from the electronic medical records maintained at the hospital in Table 1; preoperative serum creatinine values and those at postoperative week, as well as at 3, 6, 12, and 36 months after surgery, were collected. Additionally, eGFR was calculated using the Modification in Diet and Renal Disease (MORD)[7]. We defined postoperative AKI as recommended by the Kidney Disease Improving Global Outcomes 2012 guidelines: increase in plasma creatinine > 26.5 μmol/L within 48 hours, or increase in plasma creatinine > 1.5 fold baseline, which is known or presumed to have occurred within the prior 48 hours postoperatively [8]. Renal function was staged as CKD I–V according to the American Standard Stages of Renal Function [7]. 2.3. Statistical Methods SPSS software (version 25.0; IBM Corp., Armonk, NY, USA) was used to analyse the data, and a line chart was used to demonstrate the trends of data change. We presented normally distributed data as mean ± standard deviation and the non-normally distributed data as the median (25, 75 percentile). For all analyses, p < 0.05 was considered statistically significant. 2.4. Study design Firstly, the MORD formula was used to calculate changes in renal function at 3, 6, 12, and 36 months after surgery. We plotted the data of the 329 patients as line plots and placed them together (Figure 1). The rate of change at different stages was plotted in a box plot (Figure 2). We divided them into 0–3, 3–6, 6–12, and 12–36 months. We utilized line charts and box plots to observe the changes in renal function among patients, gaining insights into the trends of these changes. Secondly, we assessed the patient's CKD stage and determined whether it had increased after 36 months as a measure of renal function progression. Trend plots displayed that the changes in postoperative renal function were most obvious in the early postoperative period. Subsequently, we compared the eGFR value in the early postoperative period with the preoperative value as the rate of change in renal function. Moreover, we examined the relationship between the early rate of change in renal function, age, sex, tumour size, hypertension, diabetes mellitus, and CKD development during the 36 months after surgery using multivariate Cox proportional hazard regression analysis, as displayed in Table 2. Table 2 . Logistic regression models of influencing factors of long-term renal function Univariate analysis Multivariate analysis Variables OR 95% CI P-values OR 95% CI P-values Preoperative Renal function 0.996 0.991-1.001 0.087 0.996 0.991-1.001 0.118 Hypertension 0.808 0.520-1.257 0.344 0.823 0.486-1.393 0.467 Diabetes 1.351 0.706-2.584 0.364 1.721 0.803-3.690 0.163 Tumor size 0.925 0.858-0.998 0.039 0.939 0.863-1.021 0.143 Gender 2.015 1.270-3.195 0.003 2.007 1.188-3.393 0.009 BMI 1.012 0.972-1.054 0.562 0.998 0.956-1.043 0.942 Age 1.7 1.10-2.64 0.018 1.016 0.991-1.041 0.209 Rate of change in renal function at three months 0.007 0.001-0.033 < 0.0001 0.01 0.002-0.051 <0.0001 Thirdly, we discovered that the early rate of change in renal function was an important factor affecting long-term renal function. Therefore, we further explored the factors influencing the rate of early renal function changes, as displayed in Table 3. Linear regression was used to analyse the relationship between preoperative renal function, age, tumour size, BMI, the ratio of postoperative creatinine to preoperative creatinine, and the rate of early postoperative renal function change. Results Demographic and perioperative parameters are displayed in Table 1. The incidence of CKD escalation was 48.3% 24 months postoperatively. The incidence of postoperative AKI escalation was 43.7%. Table 3 . Linear regression analysis of Influencing factors of short-term renal function change rate Univariate analysis Multivariate analysis Variables R P-values R P-values Preoperative Renal function 0.198 <0.0001 0.131 0.004 Tumor size 0.066 <0.0001 -0.033 0.1469 Age 0.061 <0.0001 -0.129 0.005 Ratio of postoperative creatinine to preoperative creatinine -0.555 < 0.0001 -0.528 <0.0001 Based on the eGFR of the postoperative patients, we plotted the lines in Figure 1 and Figure 2. The renal function of most patients dropped rapidly within 3 months after surgery and then levelled off. Table 2 displays that the main factors influencing long-term renal function are the rate of change of renal function (p<<0.0001, odds ratio （OR）=0.004) and gender (p=0.011, OR=1.969) at this stage. The greater the decline in renal function, the poorer the long-term prognosis of renal function. Additionally, Table 3 displays that preoperative renal function (p=0.004, r=0.131), age (p=0.006, r=-0.128), and the ratio of postoperative creatinine to preoperative creatinine (p<0.0001, r=-0.528) correlate with the rate of change in renal function within 3 months after surgery. However, preoperative creatinine and age are weakly correlated. A strong correlation is observed between the ratio of postoperative creatinine to preoperative creatinine and the severity of AKI; a high ratio indicates a severe degree of AKI. Moreover, the higher this ratio, the more significant the decline in renal function. Discussion In a retrospective cohort with 36 months of follow-up, we calculated patient eGFR from the collected data and plotted the trend of postoperative renal function. Simultaneously, we used multiple-factor regression analysis to evaluate the factors influencing the long-term progress of renal function. We also plotted curves depicting renal function changes in different patients and identified key nodes in their trajectories. Top of Form The poor progression of the patient's long-term renal function after surgery was revealed and CKD grades increased. Studies have demonstrated that CKD after radical nephrectomy is associated with all-cause mortality and incidence of cardiovascular disease [5]. Furthermore, after radical nephrectomy, patients choose different adjuvant therapies such as chemotherapy, immunotherapy, and radiotherapy, according to the stage and grade of the tumour [9]. These treatments have specific requirements for renal function. Therefore, determining the factors influencing long-term renal function after surgery is crucial and necessitates the implementation of corresponding intervention measures in the early stages to prevent the occurrence of CKD. Research has proven that radical nephrectomy gradually restores renal function in patients [2, 10]. Figures 1 and 2 display that the renal function of most patients decreased after surgery. Our research also discovered that in most patients, postoperative renal function gradually declined within 3 months of surgery and remained steady after 3 months. Subsequently, the renal function of most patients gradually stabilised 3 months after surgery. For most patients, the long-term trajectory of renal function can be reasonably predicted based on the renal function observed at the 3-month mark after surgery. Additionally, one study demonstrated that 49% of patients recovered their preoperative eGFR within 2 years of radical nephrectomy for renal cell carcinoma [11]. Therefore, we believe that 3 months after surgery is the most likely period for renal function to be impacted, and the protection of renal function at this stage is crucial. In addition, Table 3 displays that the most important factor for long-term renal function was the rate of change in eGFR during the early postoperative period. During this period, owing to the removal of the affected kidney, the contralateral healthy kidney compensates for hypertrophy, thus supplying the entire body [12]. Therefore, the kidney remaining during this period, is extremely fragile, owing to the workload. Therefore, healthy kidneys may undergo permanent changes during this time, which has important implications for long-term kidney function. This is also reflected in the data obtained in our study. During this period, the influence of the eGFR change rate on long-term renal function surpassed that of age, and it has since stabilized. Hence, this period represents the optimal time for predicting and safeguarding renal function. As several studies have demonstrated that, postoperative AKI is a common complication after a radical nephrectomy [13, 14]. Some studies have suggested that postoperative AKI after radical nephrectomy is associated with the deterioration of long-term renal function [15, 16]. In our research, we studied the relationship between the ratio of postoperative creatinine to preoperative creatinine and the rate of change in renal function 3 months after surgery. The higher the ratio, the more severe the degree of AKI [8]. Therefore, AKI can be used as an indicator to reflect short-term postoperative renal function and the compensatory capacity of the kidney to further predict long-term renal function. However, we believe that postoperative AKI after radical resection differs from postoperative AKI in the other typical clinical cases. In other typical clinical cases, postoperative AKI refers to the destruction of the renal parenchyma and reduction of glomeruli caused by ischaemia, inflammation, and immune factors [17, 18]. These impairments may be permanent and irreversible; furthermore, they affect both sides simultaneously and have important implications for long-term renal function. However, the development of postoperative AKI after radical nephrectomy does not damage the contralateral healthy kidney and prompts compensatory hyperplasia in the remaining kidney [19]. Immediately after nephrectomy, a 40% increase in blood flow and GFR was observed in the kidneys [20]. This evolves into the glomeruli causing an increase in the high-pressure nephron filter, resulting in compensatory enlargement of the glomeruli [19]. Top of Form Once the glomerular volume reaches a certain threshold, glomerulosclerosis, hypertension, proteinuria, and renal failure may occur [21]. An increase in renal blood flow and GFR leads to increased oxygen consumption, which in turn leads to tissue hypoxia. The condition induces hypoxia-inducible factor 1α and vascular endothelial growth factor. Hypoxia also induces small tube phosphatases and tension homologues, leading to tubular regeneration and repair [22]. Therefore, serum creatinine levels rapidly increase after unilateral nephrectomy, leading to AKI. The occurrence and severity of AKI after nephrectomy can be used as detection indicators, enabling more informed assessments and the formulation of programs aimed at enhancing short-term renal function recovery. These strategies include reducing the pre-renal load, controlling blood pressure, and eating properly. Moreover, they contribute to long-term renal function. Conclusion In conclusion, postoperative renal function in most patients gradually declined within 3 months of surgery and remained steady after 3 months. For patients with AKI, more attention should be paid 3 months postoperatively especially in those with decreased renal function. Additionally, the implementation of appropriate measures is very important for the recovery of patients with long-term renal function. This can also help patients choose treatment options that are highly demanding in terms of renal function. Declarations Author Contributions : Yongchao Yan performed the data analyses and wrote the manuscript. Xinning Wang, Bin Li, Yunbo Liu, Shang Xu and Haotian Du did the pathological analysis and helped doing clincal management. Yanjiang Li revised the manuscript critically for important intellectual content. Funding : N/A Availability of Data and Materials: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Consent for publication: Not applicable Ethical approval statement : As this publication is a report that contains no identifiable content to the patient, this publication was exempt from ethical approval by the Human Research Protection Program (HRPP) and its Institutional Review Board (IRB) at the Ethics Committee of the affiliated hospital of Qingdao University. Informed Consent Statement : All author consent for this article publication. Data Availability Statement : N/A Acknowledgments : N/A Conflicts of Interest : The author declare that there no competing interests. Registry and the Registration No. of the study/trial: N/A Animal Studies: N/A References Ta AD, Bolton DM, Dimech MK, White V, Davis ID, Coory M, et al. Contemporary management of renal cell carcinoma (RCC) in Victoria: implications for longer term outcomes and costs. BJU International. 2013;112(S2):36-43. Liu J, Tian C, Zhang Z, Zhou G, Shi B, Zhao H, et al. Correlation between preoperatively predicted and postoperatively observed renal function using an imaging‑based approach: A retrospective cohort study. Oncology Letters. 2020;20(1):501-8. Klarenbach S, Moore RB, Chapman DW, Dong J, Braam B. Adverse Renal Outcomes in Subjects Undergoing Nephrectomy for Renal Tumors: A Population-Based Analysis. European Urology. 2011;59(3):333-9. Jeon HG, Choo SH, Sung HH, Jeong BC, Seo SI, Jeon SS, et al. Small tumour size is associated with new-onset chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma. European Journal of Cancer. 2014;50(1):64-9. Weight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317-1323. Colucci V, Gallo P, Simone S, Morrone L, Alfieri CM, Gesualdo L, et al. Long-term renal and cardiovascular outcome of living kidney donors: A single-center retrospective observation study. Frontiers in Medicine. 2022;9. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-470. Thomas ME, Blaine C, Dawnay A, Devonald MAJ, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney International. 2015;87(1):62-73. Den Hartogh DJ, Tsiani E. Health Benefits of Resveratrol in Kidney Disease: Evidence from In Vitro and In Vivo Studies. Nutrients. 2019;11(7). Zabor EC, Furberg H, Mashni J, Lee B, Jaimes EA, Russo P. Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms. Clinical Journal of the American Society of Nephrology. 2016;11(1):101-7. Zabor EC, Furberg H, Lee B, Campbell S, Lane BR, Thompson RH, et al. Long-Term Renal Function Recovery following Radical Nephrectomy for Kidney Cancer: Results from a Multicenter Confirmatory Study. Journal of Urology. 2018;199(4):921-6. Rojas‐Canales DM, Li JY, Makuei L, Gleadle JM. Compensatory renal hypertrophy following nephrectomy: When and how? Nephrology. 2019;24(12):1225-32. Cho A, Lee JE, Kwon GY, Huh W, Lee HM, Kim YG, et al. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transplant. 2011;26(11):3496-501. Garofalo C, Liberti ME, Russo D, Russo L, Fuiano G, Cianfrone P, et al. Effect of post-nephrectomy acute kidney injury on renal outcome: a retrospective long-term study. World J Urol. 2018;36(1):59-63. Kim WH, Shin KW, Ji S-H, Jang Y-E, Lee J-H, Jeong CW, et al. Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function. Journal of Clinical Medicine. 2020;9(3). Yang X, Zhang T, Zhou H, Ni Z, Wang Q, Wu J, et al. Acute kidney injury as an independent predicting factor for stage 3 or higher chronic kidney disease after nephrectomy. Urologic Oncology: Seminars and Original Investigations. 2023;41(3):149.e1-.e9. Kher A, Kher V. Prevention and Therapy of AKI in Asia: A Big Challenge. Seminars in Nephrology. 2020;40(5):477-88. Xiong C, Jia Y, Wu X, Zhao Y, Yuan S, Yan F, et al. Early Postoperative Acetaminophen Administration and Severe Acute Kidney Injury After Cardiac Surgery. American Journal of Kidney Diseases. 2023;81(6):675-83.e1. Okumura K, Grace H, Sogawa H, Yamanaga S. Acute kidney injury and the compensation of kidney function after nephrectomy in living donation. World J Transplant. 2022;12(8):223-230. Saxena AB, Myers BD, Derby G, Blouch KL, Yan J, Ho B, et al. Adaptive hyperfiltration in the aging kidney after contralateral nephrectomy. American Journal of Physiology-Renal Physiology. 2006;291(3):F629-F34. Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981;241(1):F85-F93. Polichnowski AJ, Griffin KA, Licea-Vargas H, et al. Pathophysiology of unilateral ischemia-reperfusion injury: importance of renal counterbalance and implications for the AKI-CKD transition. Am J Physiol Renal Physiol. 2020;318(5):F1086-F1099. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3988482","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276362734,"identity":"2d75ca03-de8f-4553-8187-e195bfa888a2","order_by":0,"name":"Yongchao Yan","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yongchao","middleName":"","lastName":"Yan","suffix":""},{"id":276362735,"identity":"19486b55-8394-4b83-82c3-3044f7afcb9a","order_by":1,"name":"Xinning Wang","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao 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patients\u003c/p\u003e","description":"","filename":"Figure1.TrendmapofeGFRchangesinpatients.png","url":"https://assets-eu.researchsquare.com/files/rs-3988482/v1/151c46c8787eab7658702f3d.png"},{"id":52033683,"identity":"5751762d-a3ee-49ac-836e-47a1a20411a0","added_by":"auto","created_at":"2024-03-05 16:42:24","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":404732,"visible":true,"origin":"","legend":"\u003cp\u003eThe rate of change at different stages\u003c/p\u003e","description":"","filename":"Figure2.Therateofchangeatdifferentstages.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3988482/v1/6f152304f76d518b93a0369e.jpg"},{"id":52033726,"identity":"e915b25a-04d8-49b2-b617-b6d42c5397f6","added_by":"auto","created_at":"2024-03-05 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of the patients had an increase in CKD grade.\u003c/p\u003e\n\u003cp\u003e2.The changes of short-term renal function have an important impact on the prognosis of long-term renal function.\u003c/p\u003e\n\u003cp\u003e3.We should monitor and intervene the short-term renal function of patients with unilateral nephrectomy, so as to prevent the poor prognosis of long-term renal function.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eCurrently, radical nephrectomy is the most common treatment for malignant renal tumours\u0026nbsp;[1]. Removal of the kidney inevitably reduces the functional renal parenchyma, resulting in loss of renal function\u0026nbsp;[2]. Previous studies have demonstrated that older age, high comorbidity rates, and low preoperative estimated glomerular filtration rate (eGFR) are associated with chronic kidney disease (CKD) after radical nephrectomy\u0026nbsp;[3, 4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperative CKD in patients undergoing radical nephrectomy is associated with an increased risk of all-cause and cardiovascular disease-related mortality\u0026nbsp;[5]. Previous studies have demonstrated that CKD results in increased proteinuria and blood pressure, which are associated with an increased risk of cardiovascular disease and all-cause mortality in the general population\u0026nbsp;[6]. Observing and recording changes in patients\u0026rsquo; eGFR after radical nephrectomy is crucial, and early measures should be taken to prevent CKD. Moreover, this can help improve our understanding of the changes in the renal function in patients after surgery and explore the indicators related to renal function progression.\u003c/p\u003e\n\u003cp\u003eTherefore, the present study aimed to examine the trends in renal function changes and identify risk factors for renal function deterioration in patients with renal tumours after radical nephrectomy. Furthermore, key nodes of renal function changes were also identified.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e2.1. Patient Selection\u003c/p\u003e\n\u003cp\u003eThis single-centre retrospective observational study was approved by the Institutional Review Board (IRB) of The Affiliated Hospital of Qingdao University. The requirement for written informed consent was waived by the IRB board owing to the retrospective nature of the study. Using the scientific research big data platform of our hospital, we screened patients who underwent unilateral nephrectomy for renal tumours between 2013 and 2018. To ensure the completeness of the data, 329 patients were screened according to their postoperative follow-up compliance.\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic and baseline characteristics of the patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.494949494949495%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.505050505050505%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.494949494949495%\" valign=\"top\"\u003e\n \u003cp\u003eAge, year\u003c/p\u003e\n \u003cp\u003eFemale, n\u003c/p\u003e\n \u003cp\u003eHypertension, n\u003c/p\u003e\n \u003cp\u003eDiabetes mellitus, n\u003c/p\u003e\n \u003cp\u003ePreoperative eGFR, mL/min/1.73 m2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;eGFR \u0026ge; 90 mL/min/1.73m2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; eGFR ＜90 mL/min/1.73m2\u003c/p\u003e\n \u003cp\u003eBMI,Kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eTumor size，cm\u003c/p\u003e\n \u003cp\u003eClinical stage, n\u003c/p\u003e\n \u003cp\u003eT1a\u003c/p\u003e\n \u003cp\u003eT1b\u003c/p\u003e\n \u003cp\u003eT2a\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;T2b\u003c/p\u003e\n \u003cp\u003ethe ratio of postoperative creatinine to preoperative creatinine\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAKI,n\u003c/p\u003e\n \u003cp\u003eUpgrading CKD staging,24 months,n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.505050505050505%\" valign=\"top\"\u003e\n \u003cp\u003e58(51-65)\u003c/p\u003e\n \u003cp\u003e118(35.8)\u003c/p\u003e\n \u003cp\u003e132(40.1)\u003c/p\u003e\n \u003cp\u003e43(13.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e122(37.1)\u003c/p\u003e\n \u003cp\u003e207(62.9)\u003c/p\u003e\n \u003cp\u003e25.22\u0026plusmn;5.49\u003c/p\u003e\n \u003cp\u003e5.98\u0026plusmn;2.68\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e129(39.2)\u003c/p\u003e\n \u003cp\u003e128(38.9)\u003c/p\u003e\n \u003cp\u003e50(15.1)\u003c/p\u003e\n \u003cp\u003e22(6.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.33\u0026plusmn;0.36\u003c/p\u003e\n \u003cp\u003e144(43.7)\u003c/p\u003e\n \u003cp\u003e159(48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAKI = acute kidney injury; eGFR = estimated glomerular filtration rate; BMI= Body Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2. Patient Data and Outcome Measurements\u003c/p\u003e\n\u003cp\u003eDemographic and baseline characteristics of the patients related to renal function and procedure-related data were obtained from the electronic medical records maintained at the hospital in Table 1; preoperative serum creatinine values and those at postoperative week, as well as at 3, 6, 12, and 36 months after surgery, were collected. Additionally, eGFR was calculated using the Modification in Diet and Renal Disease (MORD)[7]. We defined postoperative AKI as recommended by the Kidney Disease Improving Global Outcomes 2012 guidelines: increase in plasma creatinine \u0026gt; 26.5 \u0026mu;mol/L within 48 hours, or increase in plasma creatinine \u0026gt; 1.5 fold baseline, which is known or presumed to have occurred within the prior 48 hours postoperatively [8]. Renal function was staged as CKD I\u0026ndash;V according to the American Standard Stages of Renal Function [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.3. Statistical Methods\u003c/p\u003e\n\u003cp\u003eSPSS software (version 25.0; IBM Corp., Armonk, NY, USA) was used to analyse the data, and a line chart was used to demonstrate the trends of data change. We presented normally distributed data as mean \u0026plusmn; standard deviation and the non-normally distributed data as the median (25, 75 percentile). For all analyses, p \u0026lt; 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.4. Study design\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirstly, the MORD formula was used to calculate changes in renal function at 3, 6, 12, and 36 months after surgery. We plotted the data of the 329 patients as line plots and placed them together (Figure 1). The rate of change at different stages was plotted in a box plot (Figure 2). We divided them into 0\u0026ndash;3, 3\u0026ndash;6, 6\u0026ndash;12, and 12\u0026ndash;36 months. We utilized line charts and box plots to observe the changes in renal function among patients, gaining insights into the trends of these changes.\u003c/p\u003e\n\u003cp\u003eSecondly, we assessed the patient\u0026apos;s CKD stage and determined whether it had increased after 36 months as a measure of renal function progression. Trend plots displayed that the changes in postoperative renal function were most obvious in the early postoperative period. Subsequently, we compared the eGFR value in the early postoperative period with the preoperative value as the rate of change in renal function. Moreover, we examined the relationship between the early rate of change in renal function, age, sex, tumour size, hypertension, diabetes mellitus, and CKD development during the 36 months after surgery using multivariate Cox proportional hazard regression analysis, as displayed in Table 2.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2\u003c/strong\u003e. Logistic regression models of influencing factors of long-term renal function\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6530612244898%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.061224489795918%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69387755102041%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Multivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-values\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative Renal function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.991-1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.991-1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.520-1.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.486-1.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.706-2.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.803-3.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eTumor size \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.858-0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.863-1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e2.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.270-3.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e2.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.188-3.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.972-1.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.956-1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.10-2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.991-1.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.208333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eRate of change in renal function at three months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.001-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e0.002-0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThirdly, we discovered that the early rate of change in renal function was an important factor affecting long-term renal function. Therefore, we further explored the factors influencing the rate of early renal function changes, as displayed in Table 3. Linear regression was used to analyse the relationship between preoperative renal function, age, tumour size, BMI, the ratio of postoperative creatinine to preoperative creatinine, and the rate of early postoperative renal function change.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic and perioperative parameters are displayed in Table 1. The incidence of CKD escalation was 48.3% 24 months postoperatively. The incidence of postoperative AKI escalation was 43.7%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Linear regression analysis of Influencing factors of short-term renal function change rate\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Univariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.632653061224488%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Multivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-values\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative Renal function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003eTumor size \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.1469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e-0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003eRatio of postoperative creatinine to preoperative creatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e-0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" valign=\"top\"\u003e\n \u003cp\u003e-0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBased on the eGFR of the postoperative patients, we plotted the lines in Figure 1 and Figure 2. The renal function of most patients dropped rapidly within 3 months after surgery and then levelled off.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 displays that the main factors influencing long-term renal function are the rate of change of renal function (p\u0026lt;\u0026lt;0.0001, odds ratio\u0026nbsp;（OR）=0.004) and gender (p=0.011, OR=1.969) at this stage. The greater the decline in renal function, the poorer the long-term prognosis of renal function.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, Table 3 displays that preoperative renal function (p=0.004, r=0.131), age (p=0.006, r=-0.128), and the ratio of postoperative creatinine to preoperative creatinine (p\u0026lt;0.0001, r=-0.528) correlate with the rate of change in renal function within 3 months after surgery. However, preoperative creatinine and age are weakly correlated. A strong correlation is observed between the ratio of postoperative creatinine to preoperative creatinine and the severity of AKI; a high ratio indicates a severe degree of AKI. Moreover, the higher this ratio, the more significant the decline in renal function. \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a retrospective cohort with 36 months of follow-up, we calculated patient eGFR from the collected data and plotted the trend of postoperative renal function. Simultaneously, we used multiple-factor regression analysis to evaluate the factors influencing the long-term progress of renal function. We also plotted curves depicting renal function changes in different patients and identified key nodes in their trajectories.\u003c/p\u003e\n\u003cp\u003eTop of Form\u003c/p\u003e\n\u003cp\u003eThe poor progression of the patient\u0026apos;s long-term renal function after surgery was revealed and CKD grades increased. Studies have demonstrated that CKD after radical nephrectomy is associated with all-cause mortality and incidence of cardiovascular disease\u0026nbsp;[5]. Furthermore, after radical nephrectomy, patients choose different adjuvant therapies such as chemotherapy, immunotherapy, and radiotherapy, according to the stage and grade of the tumour\u0026nbsp;[9]. These treatments have specific requirements for renal function. Therefore, determining the factors influencing long-term renal function after surgery is crucial and necessitates the implementation of corresponding intervention measures in the early stages to prevent the occurrence of CKD.\u003c/p\u003e\n\u003cp\u003eResearch has proven that radical nephrectomy gradually restores renal function in patients\u0026nbsp;[2, 10]. Figures 1 and 2 display that the renal function of most patients decreased after surgery. Our research also discovered that in most patients, postoperative renal function gradually declined within 3 months of surgery and remained steady after 3 months. Subsequently, the renal function of most patients gradually stabilised 3 months after surgery. For most patients, the long-term trajectory of renal function can be reasonably predicted based on the renal function observed at the 3-month mark after surgery. Additionally, one study demonstrated that 49% of patients recovered their preoperative eGFR within 2 years of radical nephrectomy for renal cell carcinoma\u0026nbsp;[11]. Therefore, we believe that 3 months after surgery is the most likely period for renal function to be impacted, and the protection of renal function at this stage is crucial.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, Table 3 displays that the most important factor for long-term renal function was the rate of change in eGFR during the early postoperative period. During this period, owing to the removal of the affected kidney, the contralateral healthy kidney compensates for hypertrophy, thus supplying the entire body\u0026nbsp;[12]. Therefore, the kidney remaining during this period, is extremely fragile, owing to the workload. Therefore, healthy kidneys may undergo permanent changes during this time, which has important implications for long-term kidney function. This is also reflected in the data obtained in our study. During this period, the influence of the eGFR change rate on long-term renal function surpassed that of age, and it has since stabilized. Hence, this period represents the optimal time for predicting and safeguarding renal function.\u003c/p\u003e\n\u003cp\u003eAs several studies have demonstrated that, postoperative AKI is a common complication after a radical nephrectomy\u0026nbsp;[13, 14]. Some studies have suggested that postoperative AKI after radical nephrectomy is associated with the deterioration of long-term renal function\u0026nbsp;[15, 16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our research, we studied the relationship between the ratio of postoperative creatinine to preoperative creatinine and the rate of change in renal function 3 months after surgery. The higher the ratio, the more severe the degree of AKI\u0026nbsp;[8]. Therefore, AKI can be used as an indicator to reflect short-term postoperative renal function and the compensatory capacity of the kidney to further predict long-term renal function.\u003c/p\u003e\n\u003cp\u003eHowever, we believe that postoperative AKI after radical resection differs from postoperative AKI in the other typical clinical cases. In other typical clinical cases, postoperative AKI refers to the destruction of the renal parenchyma and reduction of glomeruli caused by ischaemia, inflammation, and immune factors\u0026nbsp;[17, 18]. These impairments may be permanent and irreversible; furthermore, they affect both sides simultaneously and have important implications for long-term renal function. However, the development of postoperative AKI after radical nephrectomy does not damage the contralateral healthy kidney and prompts compensatory hyperplasia in the remaining kidney\u0026nbsp;[19].\u003c/p\u003e\n\u003cp\u003eImmediately after nephrectomy, a 40% increase in blood flow and GFR was observed in the kidneys\u0026nbsp;[20]. This evolves into the glomeruli causing an increase in the high-pressure nephron filter, resulting in compensatory enlargement of the glomeruli\u0026nbsp;[19]. Top of Form\u003c/p\u003e\n\u003cp\u003eOnce the glomerular volume reaches a certain threshold, glomerulosclerosis, hypertension, proteinuria, and renal failure may occur\u0026nbsp;[21]. An increase in renal blood flow and GFR leads to increased oxygen consumption, which in turn leads to tissue hypoxia. The condition induces hypoxia-inducible factor 1\u0026alpha; and vascular endothelial growth factor. Hypoxia also induces small tube phosphatases and tension homologues, leading to tubular regeneration and repair\u0026nbsp;[22]. Therefore, serum creatinine levels rapidly increase after unilateral nephrectomy, leading to AKI.\u003c/p\u003e\n\u003cp\u003eThe occurrence and severity of AKI after nephrectomy can be used as detection indicators, enabling more informed assessments and the formulation of programs aimed at enhancing short-term renal function recovery. These strategies include reducing the pre-renal load, controlling blood pressure, and eating properly. Moreover, they contribute to long-term renal function.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, postoperative renal function in most patients gradually declined within 3 months of surgery and remained steady after 3 months. For patients with AKI, more attention should be paid 3 months postoperatively especially in those with decreased renal function. Additionally, the implementation of appropriate measures is very important for the recovery of patients with long-term renal function. This can also help patients choose treatment options that are highly demanding in terms of renal function.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: Yongchao Yan performed the data analyses and wrote the manuscript. Xinning Wang, Bin Li, Yunbo Liu, Shang Xu and Haotian Du did the pathological analysis and helped doing clincal management. Yanjiang Li revised the manuscript critically for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval statement\u003c/strong\u003e: As this publication is a report that contains no identifiable content to the patient, this publication was exempt from ethical approval by the Human Research Protection Program (HRPP) and its Institutional Review Board (IRB) at the Ethics Committee of the affiliated hospital of Qingdao University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e: All author consent for this article publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e: N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: N/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e: The author declare that there no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistry and the Registration No. \u0026nbsp; of the study/trial:\u0026nbsp;\u003c/strong\u003eN/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnimal Studies:\u0026nbsp;\u003c/strong\u003eN/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTa AD, Bolton DM, Dimech MK, White V, Davis ID, Coory M, et al. Contemporary management of renal cell carcinoma (RCC) in Victoria: implications for longer term outcomes and costs. BJU International. 2013;112(S2):36-43.\u003c/li\u003e\n \u003cli\u003eLiu J, Tian C, Zhang Z, Zhou G, Shi B, Zhao H, et al. Correlation between preoperatively predicted and postoperatively observed renal function using an imaging‑based approach: A retrospective cohort study. Oncology Letters. 2020;20(1):501-8.\u003c/li\u003e\n \u003cli\u003eKlarenbach S, Moore RB, Chapman DW, Dong J, Braam B. Adverse Renal Outcomes in Subjects Undergoing Nephrectomy for Renal Tumors: A Population-Based Analysis. European Urology. 2011;59(3):333-9.\u003c/li\u003e\n \u003cli\u003eJeon HG, Choo SH, Sung HH, Jeong BC, Seo SI, Jeon SS, et al. Small tumour size is associated with new-onset chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma. European Journal of Cancer. 2014;50(1):64-9.\u003c/li\u003e\n \u003cli\u003eWeight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses.\u0026nbsp;J Urol. 2010;183(4):1317-1323.\u003c/li\u003e\n \u003cli\u003eColucci V, Gallo P, Simone S, Morrone L, Alfieri CM, Gesualdo L, et al. Long-term renal and cardiovascular outcome of living kidney donors: A single-center retrospective observation study. Frontiers in Medicine. 2022;9.\u003c/li\u003e\n \u003cli\u003eLevey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.\u0026nbsp;Ann Intern Med. 1999;130(6):461-470.\u003c/li\u003e\n \u003cli\u003eThomas ME, Blaine C, Dawnay A, Devonald MAJ, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney International. 2015;87(1):62-73.\u003c/li\u003e\n \u003cli\u003eDen Hartogh DJ, Tsiani E. Health Benefits of Resveratrol in Kidney Disease: Evidence from In Vitro and In Vivo Studies. Nutrients. 2019;11(7).\u003c/li\u003e\n \u003cli\u003eZabor EC, Furberg H, Mashni J, Lee B, Jaimes EA, Russo P. Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms. Clinical Journal of the American Society of Nephrology. 2016;11(1):101-7.\u003c/li\u003e\n \u003cli\u003eZabor EC, Furberg H, Lee B, Campbell S, Lane BR, Thompson RH, et al. Long-Term Renal Function Recovery following Radical Nephrectomy for Kidney Cancer: Results from a Multicenter Confirmatory Study. Journal of Urology. 2018;199(4):921-6.\u003c/li\u003e\n \u003cli\u003eRojas‐Canales DM, Li JY, Makuei L, Gleadle JM. Compensatory renal hypertrophy following nephrectomy: When and how? Nephrology. 2019;24(12):1225-32.\u003c/li\u003e\n \u003cli\u003eCho A, Lee JE, Kwon GY, Huh W, Lee HM, Kim YG, et al. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transplant. 2011;26(11):3496-501.\u003c/li\u003e\n \u003cli\u003eGarofalo C, Liberti ME, Russo D, Russo L, Fuiano G, Cianfrone P, et al. Effect of post-nephrectomy acute kidney injury on renal outcome: a retrospective long-term study. World J Urol. 2018;36(1):59-63.\u003c/li\u003e\n \u003cli\u003eKim WH, Shin KW, Ji S-H, Jang Y-E, Lee J-H, Jeong CW, et al. Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function. Journal of Clinical Medicine. 2020;9(3).\u003c/li\u003e\n \u003cli\u003eYang X, Zhang T, Zhou H, Ni Z, Wang Q, Wu J, et al. Acute kidney injury as an independent predicting factor for stage 3 or higher chronic kidney disease after nephrectomy. Urologic Oncology: Seminars and Original Investigations. 2023;41(3):149.e1-.e9.\u003c/li\u003e\n \u003cli\u003eKher A, Kher V. Prevention and Therapy of AKI in Asia: A Big Challenge. Seminars in Nephrology. 2020;40(5):477-88.\u003c/li\u003e\n \u003cli\u003eXiong C, Jia Y, Wu X, Zhao Y, Yuan S, Yan F, et al. Early Postoperative Acetaminophen Administration and Severe Acute Kidney Injury After Cardiac Surgery. American Journal of Kidney Diseases. 2023;81(6):675-83.e1.\u003c/li\u003e\n \u003cli\u003eOkumura K, Grace H, Sogawa H, Yamanaga S. Acute kidney injury and the compensation of kidney function after nephrectomy in living donation.\u0026nbsp;World J Transplant. 2022;12(8):223-230.\u003c/li\u003e\n \u003cli\u003eSaxena AB, Myers BD, Derby G, Blouch KL, Yan J, Ho B, et al. Adaptive hyperfiltration in the aging kidney after contralateral nephrectomy. American Journal of Physiology-Renal Physiology. 2006;291(3):F629-F34.\u003c/li\u003e\n \u003cli\u003eHostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981;241(1):F85-F93.\u003c/li\u003e\n \u003cli\u003ePolichnowski AJ, Griffin KA, Licea-Vargas H, et al. Pathophysiology of unilateral ischemia-reperfusion injury: importance of renal counterbalance and implications for the AKI-CKD transition. Am J Physiol Renal Physiol. 2020;318(5):F1086-F1099.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"renal function, short term changes, long-term prognosis, AKI, CKD","lastPublishedDoi":"10.21203/rs.3.rs-3988482/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3988482/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Chronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation.\u003c/p\u003e\n\u003cp\u003eObjective: This study aimed to investigate the trends in renal function changes and risk factors for renal function deterioration in patients with renal tumours after radical nephrectomy.\u003c/p\u003e\n\u003cp\u003eResults: We analysed the data from 329 patients with renal tumours undergoing radical nephrectomies between January 2013 and December 2018. We monitored the changes in the patient’s renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression. In this study, 43.7% of patients had postoperative acute kidney injury (AKI) and 48.3% had upgraded CKD stages. Further research revealed that the patient’s renal function levelled off 3 months following surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function in patients.\u003c/p\u003e\n\u003cp\u003eConclusion: AKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy.\u003c/p\u003e","manuscriptTitle":"Trends and predictors of changes in renal function after radical nephrecto my for renal tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 16:42:16","doi":"10.21203/rs.3.rs-3988482/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-13T16:10:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-09T07:57:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-03T00:44:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-02T22:04:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39760744-3826-4b40-a297-8f6a41b30daa","date":"2024-03-02T14:41:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"f3ffb1a3-e670-4166-932a-731a6cef4ef6","date":"2024-03-02T05:51:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4022ff38-e6a8-4299-8a2a-1cf8a1b15b96","date":"2024-03-02T02:14:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-01T19:45:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-01T19:33:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-01T13:41:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-01T13:39:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-02-25T16:14:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f9fc0f7-a0a4-402b-ba5c-accaca604e5b","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-06T11:54:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-05 16:42:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3988482","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3988482","identity":"rs-3988482","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}