Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes

Abstract

Background: The standard of care for surgically resectable disease renal cell carcinoma (RCC) is a nephrectomy. Post nephrectomy, these patients are at  risk for the development of new onset chronic kidney disease or the progression of pre-existing chronic kidney disease. We aimed to report the changes  in renal function in patients who had a nephrectomy for RCC.

Methods: This retrospective, descriptive, cross-sectional study identified 137 patients who had a nephrectomy for RCC from 1 January 2009 to 31  December 2017. The pre-nephrectomy and post-nephrectomy estimated glomerular filtration rate (eGFR) and the histological subtype of RCC on  histopathological analysis of the resected specimen were recorded from the National Health Laboratory Services online results platform. All analyses  were conducted using SPSS (Version 25) and the significance level was set at p < 0.05.

Results: After a mean follow-up period of 26.5 ± 22 months (median = 19 months), the patients’ eGFR dropped by a mean of 4.82 ± 8.67 ml/min/1.73 m²  (95% CI 3.23–6.41) post-nephrectomy. The mean eGFR fall in patients’ who had hypertension and/or diabetes (n = 63) was significantly larger compared to  patients who had neither of these comorbidities (n = 54; p < .001; mean = 7.30 ± 8.40 ml/min/1.73 m2 (95% CI 5.19–9.42) and 1.93 ± 8.14 ml/min/1.73  m² (95% CI 0.30–4.15) respectively.

Conclusions: The decline in renal function in patients with hypertension and/or diabetes mellitus is more pronounced than in patients with neither of  these comorbidities. In these high-risk patients, measures must be taken to prevent the development and limit the progression of chronic kidney disease.