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

Matthew G. Kaag, Landon Trost, R. Houston Thompson, Ricardo Favaretto, Vanessa Elliott, Shahrokh F. Shariat, Alexandra Maschino, Emily Vertosick, Jay Raman, Guido Dalbagni

Research output: Contribution to journalArticle

22 Citations (Scopus)

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] ≥60 mL/min/1.73 m2) 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 (≥60 mL/min/1.73 m2), 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 60 mL/min/1.73 m2 (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.

Original languageEnglish (US)
Pages (from-to)674-679
Number of pages6
JournalBJU International
Volume114
Issue number5
DOIs
StatePublished - Nov 1 2014

Fingerprint

Glomerular Filtration Rate
Carcinoma
Kidney
Cisplatin
Drug Therapy
Adjuvant Chemotherapy
Chronic Renal Insufficiency
Comorbidity
Epidemiology

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kaag, M. G., Trost, L., Thompson, R. H., Favaretto, R., Elliott, V., Shariat, S. F., ... Dalbagni, G. (2014). Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma. BJU International, 114(5), 674-679. https://doi.org/10.1111/bju.12597
Kaag, Matthew G. ; Trost, Landon ; Thompson, R. Houston ; Favaretto, Ricardo ; Elliott, Vanessa ; Shariat, Shahrokh F. ; Maschino, Alexandra ; Vertosick, Emily ; Raman, Jay ; Dalbagni, Guido. / Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma. In: BJU International. 2014 ; Vol. 114, No. 5. pp. 674-679.
@article{2cba2a88e4dd4be3b0dfddf12c842228,
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] ≥60 mL/min/1.73 m2) 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 (≥60 mL/min/1.73 m2), 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 60 mL/min/1.73 m2 (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.",
author = "Kaag, {Matthew G.} and Landon Trost and Thompson, {R. Houston} and Ricardo Favaretto and Vanessa Elliott and Shariat, {Shahrokh F.} and Alexandra Maschino and Emily Vertosick and Jay Raman and Guido Dalbagni",
year = "2014",
month = "11",
day = "1",
doi = "10.1111/bju.12597",
language = "English (US)",
volume = "114",
pages = "674--679",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "5",

}

Kaag, MG, Trost, L, Thompson, RH, Favaretto, R, Elliott, V, Shariat, SF, Maschino, A, Vertosick, E, Raman, J & Dalbagni, G 2014, 'Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma', BJU International, vol. 114, no. 5, pp. 674-679. https://doi.org/10.1111/bju.12597

Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma. / Kaag, Matthew G.; Trost, Landon; Thompson, R. Houston; Favaretto, Ricardo; Elliott, Vanessa; Shariat, Shahrokh F.; Maschino, Alexandra; Vertosick, Emily; Raman, Jay; Dalbagni, Guido.

In: BJU International, Vol. 114, No. 5, 01.11.2014, p. 674-679.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma

AU - Kaag, Matthew G.

AU - Trost, Landon

AU - Thompson, R. Houston

AU - Favaretto, Ricardo

AU - Elliott, Vanessa

AU - Shariat, Shahrokh F.

AU - Maschino, Alexandra

AU - Vertosick, Emily

AU - Raman, Jay

AU - Dalbagni, Guido

PY - 2014/11/1

Y1 - 2014/11/1

N2 - 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] ≥60 mL/min/1.73 m2) 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 (≥60 mL/min/1.73 m2), 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 60 mL/min/1.73 m2 (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.

AB - 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] ≥60 mL/min/1.73 m2) 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 (≥60 mL/min/1.73 m2), 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 60 mL/min/1.73 m2 (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.

UR - http://www.scopus.com/inward/record.url?scp=84912125512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84912125512&partnerID=8YFLogxK

U2 - 10.1111/bju.12597

DO - 10.1111/bju.12597

M3 - Article

C2 - 24314050

AN - SCOPUS:84912125512

VL - 114

SP - 674

EP - 679

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 5

ER -