Study Suggests Rising Incidence of Acute Kidney Injury Following RN and PN

The incidence of acute kidney injury (AKI) following radical nephrectomy (RN) and partial nephrectomy (PN) appears to be rising, according to a study published in the Journal of Urology.¹ Researchers reported that there must be a greater awareness of AKI incidence and improved efforts to identify patients at high risk prior to surgery.

Marianne Schmid and colleagues reported that several steps are warranted to reverse this trend, including “collaboration with nephrologists, implementation of renoprotective strategies, and long-term renal functional follow-up.”

Thomas Schwaab, MD, PhD, associate professor of oncology in the department of urology at Roswell Park Cancer Institute in Buffalo, NY, said he was not surprised with these findings. But he agreed that greater efforts must be put in place to prevent AKI among patients who undergo RN and PN, stressing the study’s significant clinical implications.

“What needs to be done is 2-fold. First, patients with kidney tumors need to be counseled by doctors with expertise in all 3 treatment modalities: PN, RN, and active surveillance for small and slow-growing kidney cancers,” Dr Schwaab told Cancer Therapy Advisor. “Secondly, experience matters. The more experienced the surgeon is, the better the outcomes will be.”

Alexander Kutikov, MD, associate professor of urologic oncology at Fox Chase Cancer Center in Philadelphia, PA, said it is important to note that these data are preliminary and urged caution when interpreting them.

“Although these data are from a strong and well-respected group, they have been reported in abstract only, were submitted more than a year ago, and have not yet been optimized for peer review,” Dr Kutikov told Cancer Therapy Advisor. “For instance, it is possible—and in this case likely—that over the period of the study, higher fidelity coding for AKI occurred, making it look like the incidence of AKI is rising.”

The researchers investigated the incidence, trends, and predictors of postoperative AKI in a large cohort of patients with renal cell carcinoma (RCC) treated with RN or PN. All patients were treated between January 1998 and December 2010 and were identified within the Nationwide Inpatient Sample. The team looked at associations between AKI and in-hospital complications and mortality, as well as length of stay in the hospital and charges following RN or PN. They used logistic regression models adjusted for clustering and identified predictors of AKI using multivariable logistic regression analysis.

The study cohort included 253 222 patients (78.1%) who underwent RN and 71 176 (21.9%) who underwent PN. Among all the patients, 17 828 (5.5%) experienced AKI. The researchers reported that the incidence of AKI following RN or PN significantly increased over the 12-year study period and that higher overall incidence of AKI was observed after RN compared with PN. The researchers reported that all incidences of AKI were associated with increased costs and that predictors of AKI included older age, higher comorbid status, higher chronic kidney disease stage, and surgery at urban hospitals.