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Article Dans Une Revue Urologic Oncology: Seminars and Original Investigations Année : 2014

Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: a multi-institutional study

J. J. Patard
  • Fonction : Auteur
Benoit Peyronnet
T. Bessède
  • Fonction : Auteur
P. Laguna
  • Fonction : Auteur
K. Barwari
  • Fonction : Auteur
Jean-Baptiste Rigaud
M. Roupret
  • Fonction : Auteur
  • PersonId : 862047
G. Coffin
  • Fonction : Auteur
J. C. Bernhard
  • Fonction : Auteur
J. A. Long
  • Fonction : Auteur
A. Zisman
  • Fonction : Auteur
J. Berger
C. Maurin
  • Fonction : Auteur
E. Lechevallier
  • Fonction : Auteur
R. Bertini
  • Fonction : Auteur
I. Ouzaid
  • Fonction : Auteur
A. Bex
  • Fonction : Auteur
R. Farfara
  • Fonction : Auteur
B. Ljungberg
  • Fonction : Auteur
A. R. Rodriguez
  • Fonction : Auteur
K. Bensalah
  • Fonction : Auteur

Résumé

OBJECTIVE: Partial Nephrectomy (PN) in a solitary kidney is at risk of chronic kidney disease (CKD) stage V and/or haemodialysis (HD). Our objective was to determine predictive factors of CKD stage V in this population. MATERIAL & METHODS: Data from 300 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics and renal function before surgery were analyzed. Patients with and without CKD stage V (defined as MDRD\textless1 5 ml/min) were compared using χ2 and Student-t tests for qualitative and quantitative variables, respectively. Predictive factors of CKD stage V were evaluated with a multivariable analysis using a Cox regression model. RESULTS: Median age and BMI were 63 years old and 26 kg/m², respectively. Most of the patients (65%) were male with an anatomic solitary kidney (88.3%). Median tumor size was 4 cm and 98% were malignant tumors. Median operative time, blood loss and clamping time were 180 min, 350 ml and 20 min respectively. Renal cooling was used in 19.3% and clamping of the pedicle was performed in 61.6%. Twenty five patients (8.5%) presented post operative CKD stage V at last follow-up and 18 underwent HD (6%) post-operatively because of acute renal insufficiency. There was no difference between CKD stage V and non CKD stage V patients concerning Charlson index, operative time (180 min vs 179 min, p = 0.39), blood loss (475 ml vs 350 ml, p = 0.51), use of renal cooling and type of clamping. Patients with CKD stage V were older (70 vs 63 years old, p = 0.005), had a lower baseline renal function (clearance MDRD 41 vs. 62 ml/min, p\textless0.0001) and an increased tumor size (p = 0.02). Complications occurred in 91 patients (30%) with 16% of minor (Clavien 1-2) and 14% of major (Clavien \textgreater 2) complications, respectively. In multivariable analysis, baseline MDRD, BMI, and the occurrence of a minor complication were independent predictive factors of post operative CKD stage V. CONCLUSION: PN in a solitary kidney is at risk of post-operative CKD stage V and HD. Pre-operative altered renal function and post operative complications are the main predictive factors of permanent CKD stage V.
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Dates et versions

hal-01068046 , version 1 (24-09-2014)

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G. Verhoest, J. J. Patard, E. Oger, N. Rioux-Leclercq, Benoit Peyronnet, et al.. Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: a multi-institutional study. Urologic Oncology: Seminars and Original Investigations, 2014, 32 (1), pp.28.e21--26. ⟨10.1016/j.urolonc.2012.10.003⟩. ⟨hal-01068046⟩
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