Article Abstract

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

Authors: 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


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.