Acute Kidney Injury Causes Chronic Kidney Disease Progression after Partial Nephrectomy: A Retrospective Study Identifying Patients at Risk.

Introduction: The aim of this study was to assess parameters predicting acute kidney injury (AKI) and chronic kidney disease progression (CKDP) after partial nephrectomy (PN).

Methods: The data of 785 patients were retrospectively reviewed. Follow-up eGFR was assessed in 542 patients. Patient characteristics, comorbidities, medication, and type of surgery were analyzed using group comparison and logistic regression.

Results: Age (OR: 1.027 95% CI: 1.008-1.047; p = 0.006), male sex (OR: 2.128 95% CI: 1.506-3.007; p < 0.001), anemia (OR: 2.423 95% CI: 1.521-3.858; p < 0.001), CKD (OR: 1.742 95% CI: 1.084-2.800; p = 0.022), open PN (OR: 3.190 95% CI: 1.958-5.198; p < 0.001), ischemia (WIT) (OR: 1.049 95% CI: 1.027-1.072; p < 0.001), and surgery time (OR: 1.005 95% CI: 1.001-1.008; p = 0.008) were independent predictors of AKI. CKDP occurred in 224 (41.3%) patients, of whom 137 (61.2%) had experienced AKI (p < 0.001). Incidence increased with each AKI stage, which was the only independent predictor of CKDP (OR: 2.391 95% CI: 1.603-3.567; p < 0.001). Patient characteristics, approach, and WIT had no significant impact on CKDP.

Conclusion: AKI determines CKDP. Renal function loss increased at each AKI stage. We identified patients at risk for AKI, who could benefit from minimally invasive surgery and perioperative assessment in a team with nephrologists. As WIT did not influence CKDP, surgeons might consider prioritizing oncological outcomes, without compromising renal function through unnecessarily strict WIT limitations.