Zabell J, et al. – Researchers undertook this study to assess predictors of chronic kidney disease (CKD) at 5–years and non-renal cancer mortality (NRCM) 10–years after renal cancer surgery (RCS). The data indicated that glomerular filtration rate loss related to renal cancer surgery, whether due to partial nephrectomy or radical nephrectomy, influences risk of developing CKD, but may have less impact on survival. On the other hand, age and preoperative glomerular filtration rate, which reflects general health status, are more robust predictors of non-renal cancer mortality, at least for patients with good preoperative function or mild CKD.

Methods

• Clinicians examined 4,283 patients undergoing RCS (1997–2008).
• They conducted radical nephrectomy (RN) and partial nephrectomy (PN) in 46%/54% of patients, respectively.
• They applied cumulative probability ordinal modeling to predict CKD status 5–years after surgery and multivariable logistic regression for predicting NRCM at 10–years.
• In this analysis, relevant patient, tumor, and functional covariates were incorporated, including: A) preoperative glomerular filtration rate (GFR); B) new–baseline GFR after surgery; and C) GFR loss related to surgery=(A–B).
• On the other hand, PN/RN was not utilized in the models due to concerns about strong selection biases correlated with choice of procedure.

Results

• Although age/gender/race played secondary roles, multivariable modeling (Spearman rho=0.78) established preoperative GFR and GFR loss related to surgery as the most important predictors for development of CKD.
• The obtained data indicate that significant predictors of 10–year NRCM were preoperative GFR, new–baseline GFR, age, diabetes, and heart disease (all p
• The evidence showed that multivariable modeling (c–index=0.71) established age and preoperative GFR as the most important predictors of 10–year NRCM, while GFR loss related to surgery only changed absolute mortality estimates by 13%.