Presentation Authors: Andrew Sun*, Stanford, CA, I-Chun Thomas, Palo Alto, CA, Calyani Ganesan, Alan Pao, Todd Wagner, James Brooks, Glenn Chertow, John Leppert, Stanford, CA
Introduction: Patients are at risk of developing chronic kidney disease (CKD) after radical and partial nephrectomy. Severity of albuminuria is associated with CKD progression in patients with medical CKD, but it is unknown if quantitative assessment of albuminuria is associated with outcomes following nephrectomy. We assessed if the urine albumin/creatinine ratio (UACR) is associated with progressive CKD after nephrectomy.
Methods: We identified patients who underwent nephrectomy from 2004 - 2014 within the Veterans Health Administration, had a UACR measured in the 12 months before surgery, and a preoperative estimated glomerular filtration rate (eGFR) â‰¥30 mL/min/1.73 m2. We fit multivariable regression models to determine if the UACR was associated with development of stage 4 CKD. We performed a parallel analysis assessing development of stage 3B CKD among patients with normal or near-normal preoperative kidney function (eGFR â‰¥60 mL/min/1.73 m2). Last, we examined overall survival.
Results: In this cohort of 1930 patients, 658 (34.1%) and 157 (8.1%) had moderate or severe albuminuria, respectively. Albuminuria severity was associated with progressive CKD after radical (moderate albuminuria HR 1.75, 95% CI 1.41-2.17; severe albuminuria HR 2.28, 95% CI 1.66-3.13) and partial nephrectomy (moderate albuminuria HR 1.82, 95% CI 1.22-2.70; severe albuminuria HR 3.68, 95% CI 2.24-6.05) (Table 1). A similar association was seen with overall survival.
Conclusions: In patients undergoing nephrectomy, assessing the severity of albuminuria via the UACR can help stratify the risk of progressive CKD and help identify patients who would benefit from partial nephrectomy and medical optimization before surgery.
Source of Funding: The authors were supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (DK089086 to JTL and DK085446 to GMC) at the National Institutes of Health (NIH). This work was supported using resources and facilities at the