Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction-Tumour Nephrectomy Database study

Robert J Ellis; Sharon J Del Vecchio; Keng Lim Ng; Goce Dimeski; Elaine M Pascoe; Carmel M Hawley; David W Johnson; David A Vesey; Jeff S Coombes; Christudas Morais; Ross S Francis; Simon T Wood; Glenda C Gobe

doi:10.21037/tau.2017.08.15

Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction-Tumour Nephrectomy Database study

Transl Androl Urol. 2017 Oct;6(5):899-909. doi: 10.21037/tau.2017.08.15.

Authors

Robert J Ellis^{1

2

3}, Sharon J Del Vecchio^{1

2

3}, Keng Lim Ng^{1

2

3}, Goce Dimeski^{1

4}, Elaine M Pascoe^{3

5}, Carmel M Hawley^{1

3

5

6}, David W Johnson^{1

3

5

6}, David A Vesey^{1

3

6}, Jeff S Coombes^{7

8}, Christudas Morais^{1

3}, Ross S Francis^{1

3

5

6}, Simon T Wood^{1

2

3}, Glenda C Gobe^{1

3

7}

Affiliations

¹ Kidney Disease Research Group, Diamantina Institute, Faculty of Medicine, University of Queensland, Brisbane, Australia.
² Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.
³ Translational Research Institute, Brisbane, Australia.
⁴ Department of Chemical Pathology, Princess Alexandra Hospital, Brisbane, Australia.
⁵ Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia.
⁶ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
⁷ UQ NHMRC Chronic Kidney Disease Centre for Research Excellence (CKD.QLD), Royal Brisbane and Women's Hospital, Brisbane, Australia.
⁸ School of Human Movement and Nutrition Science, University of Queensland, Brisbane, Australia.

Abstract

Background: To identify factors associated with acutely elevated serum creatinine (SCr) within 7 days of radical tumour nephrectomy.

Methods: The study population consisted of 130 consecutive patients managed for renal tumours. The primary outcome was acute kidney injury (AKI) (defined as SCr increase ≥50% above baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase, assessed using multivariable linear regression analysis.

Results: Following nephrectomy, the mean percentage increase in SCr in the first week was 55%±29%, and 77 (59%) patients experienced AKI. Independent predictors of AKI post-nephrectomy were male gender [adjusted odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.01, 6.93], urine albumin-creatinine ratio (OR: 0.66; 95% CI: 0.47, 0.91), preoperative estimated glomerular filtration rate (eGFR) (OR: 1.03; 95% CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95% CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (RCC) (OR: 2.93; 95% CI: 1.04, 8.29). Independent predictors of a SCr increase were male gender (β: 12.0; 95% CI: 2.69, 21.3), urine albumin-creatinine ratio (β: -3.36; 95% CI: -6.55, -0.16), preoperative eGFR (β: 0.38; 95% CI: 0.10, 0.66), laparoscopic nephrectomy (β: 12.7; 95% CI: 1.05, 24.3) and obesity (β: 9.94, 95% CI: 0.61, 19.3).

Conclusions: Male gender, albuminuria, eGFR and laparoscopic nephrectomy independently associated with acutely elevated serum creatinine following radical tumour nephrectomy.

Keywords: Acute kidney injury (AKI); glomerular filtration rate; kidney neoplasms; radical nephrectomy; renal cell carcinoma (RCC).