Nearly Half of Patients Recovered Kidney Function After Radical Nephrectomy

A large proportion of patients who underwent radical nephrectomy for kidney tumors were able to recover to their preoperative renal function, according to the results of a study published in the Journal of Urology. This study confirmed the findings from a prior single-institution study that showed that about one-half of patients recovered to preoperative estimated glomerular filtration rate (eGFR) within 2 years of nephrectomy.

“Overall this study confirms that a substantial proportion of patients experience eGFR recovery following radical nephrectomy, that this recovery differs according to preoperative eGFR, and that tumor size and patient sex are important factors associated with eGFR recovery,” wrote Emily C. Zabor, MS, of the department of epidemiology and biostatistics at the Memorial Sloan Kettering Cancer Center in New York, and colleagues.

Radical nephrectomy is associated with a risk for postoperative reduction in renal function. Zabor and colleagues previously reported results from a study at Memorial Sloan Kettering Cancer Center than showed that 49% of patients who underwent radical nephrectomy for kidney cancer recovered to their preoperative eGFR within 2 years of surgery. The study also showed that younger age, preoperative eGFR less than 60, and female sex were associated with a greater chance of eGFR recovery.

Here they conducted a multicenter retrospective study at three centers with a high volume of kidney surgery to confirm these findings. The study included 1,928 patients undergoing radical nephrectomy for non-metastatic renal cell carcinoma. The median age of patients was 64 and median preoperative eGFR was 71.9 ml/min/1.73 m².

Those patients with preoperative eGFR less than 60 were significantly older and more frequently had diabetes and hypertension compared with patients with preoperative eGFR of 60 or greater.

During a median follow-up of 3.7 years, 883 patients (45%) had recovery to preoperative eGFR by 2 years. In addition, the results confirmed that recovery of renal function was increased among those patients with lower preoperative eGFR. The 2-year cumulative incidence of eGFR recovery was 36% among those with preoperative eGFR of 60 or greater and 67% among those with eGFR less than 60.

Multivariable analysis showed that female sex (hazard ratio, 1.33; 95% CI, 1.13–1.57) was associated with increased chance of eGFR recovery in patients with a preoperative level of 60 or greater. Increasing tumor size was significantly associated with increased chance of eGFR recovery regardless of preoperative eGFR levels.

According to the researchers, “this finding suggests that low eGFR should not be seen as a contraindication for a radical nephrectomy when such a procedure is otherwise indicated since the 1-year cumulative incidence of recovery was 64% in patients with preoperative eGFR < 60 in this study.”