THE ALBUMIN-CREATININE RATIO AND KIDNEY FUNCTION OUTCOMES AFTER NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (MP31)1 Apr 2019MP31-12 THE ALBUMIN-CREATININE RATIO AND KIDNEY FUNCTION OUTCOMES AFTER NEPHRECTOMY Andrew Sun*, I-Chun Thomas, Calyani Ganesan, Alan Pao, Todd Wagner, James Brooks, Glenn Chertow, and John Leppert Andrew Sun*Andrew Sun* More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Calyani GanesanCalyani Ganesan More articles by this author , Alan PaoAlan Pao More articles by this author , Todd WagnerTodd Wagner More articles by this author , James BrooksJames Brooks More articles by this author , Glenn ChertowGlenn Chertow More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555849.78956.baAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: 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) ≥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 ≥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 VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. Stanford, CA; Palo Alto, CA; Stanford, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e436-e437 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Sun* More articles by this author I-Chun Thomas More articles by this author Calyani Ganesan More articles by this author Alan Pao More articles by this author Todd Wagner More articles by this author James Brooks More articles by this author Glenn Chertow More articles by this author John Leppert More articles by this author Expand All Advertisement PDF downloadLoading ...