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Inicio Actas Urológicas Españolas (English Edition) Impact of radical nephrectomy on kidney function and prognostic factors for adve...
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Vol. 44. Issue 4.
Pages 239-244 (May 2020)
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Vol. 44. Issue 4.
Pages 239-244 (May 2020)
Original article
Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events
Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos
J.A. Campos-Sañudoa,
Corresponding author
jose.antonio.campos.s@gmail.com

Corresponding author.
, R. Ballestero-Diegob, S. Zubillaga-Guerrerob, J.C. Rodríguez-SanJuanc, J.M. Monge-Mirallasa, D. Crespo-Santiagod
a Servicio de Urología, Hospital Sierrallana, Torrelavega, Cantabria, Spain
b Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
c Departamento de Cirugía, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
d Departamento de Anatomía, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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Tables (3)
Table 1. Clinical variables of the patients.
Table 2. Oncological variables of the patients.
Table 3. Univariate and multivariate analysis of the predictors of adverse cardiovascular event.
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Abstract
Introduction and objectives

To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up.

Material and methods

Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses.

Results

There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0.123–0.594, p<0.001), diabetes (0.364, 95% CI 0.162–0.818 p=0.015) and de novo hypertension (0.239, 95% CI 0.098–0.581, p=0.002) as independently associated with the occurrence of adverse cardiovascular events.

Conclusion

There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60ml/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Keywords:
Nephrectomy
Chronic kidney disease
Cardiovascular event
Hypertension
Kidney cancer
Resumen
Introducción y objetivos

Analizar la evolución de la función renal tras nefrectomía e investigar la existencia de factores de riesgo de aparición de eventos cardiovasculares adversos (ECVA) durante el seguimiento a largo plazo.

Material y métodos

Estudio retrospectivo de los pacientes a los que se realizó una nefrectomía radical por neoplasia renal en nuestro hospital en el periodo comprendido entre enero del 1996 y enero del 2016. Analizamos la función renal posnefrectomía y durante seguimiento a largo plazo. Estudiamos los predictores de ECVA mediante análisis multivariante.

Resultados

Se produjo un descenso marcado de la filtración glomerular tras nefrectomía (–21.2ml/min), que posteriormente durante el seguimiento se mantuvo estable en la mayoría de casos. En el análisis de regresión logística, donde valoramos en nuestro grupo de pacientes qué factores se muestran como predictores de la aparición de un evento cardiovascular, la presencia de enfermedad cardiovascular previa (0,270, IC del 95%, 0,123-0,594, p<0,001), diabetes (0,364, IC del 95%, 0,162-0,818, p=0,015) e hipertensión arterial de novo (0,239, IC del 95%, 0,098-0,581, p=0,002) se asociaron de manera independiente con la aparición de ECVA.

Conclusión

Tras nefrectomía se produce un deterioro de la función renal marcado que se mantiene estable durante los años sucesivos en la mayoría de pacientes. Aproximadamente la mitad de los pacientes presentan una tasa estimada de filtración glomerular menor de 60ml/min tras la nefrectomía. La presencia de enfermedad cardiovascular previa, diabetes e hipertensión arterial denovo tras nefrectomía fueron factores predictores para la aparición de ECVA tras la cirugía.

Palabras clave:
Nefrectomía
Insuficiencia renal crónica
Evento cardiovascular
Hipertensión
Cáncer renal

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