Medicina (Mar 2024)

Preoperative Age and Its Impact on Long-Term Renal Functional Decline after Robotic-Assisted Partial Nephrectomy: Insights from a Tertiary Referral Center

  • Cesare Saitta,
  • Giuseppe Garofano,
  • Giovanni Lughezzani,
  • Margaret F. Meagher,
  • Kit L. Yuen,
  • Vittorio Fasulo,
  • Pietro Diana,
  • Alessandro Uleri,
  • Andrea Piccolini,
  • Stefano Mancon,
  • Paola Arena,
  • Federica Sordelli,
  • Matilde Mantovani,
  • Pier Paolo Avolio,
  • Edoardo Beatrici,
  • Rodolfo F. Hurle,
  • Massimo Lazzeri,
  • Alberto Saita,
  • Paolo Casale,
  • Ithaar H. Derweesh,
  • Marco Paciotti,
  • Nicolò M. Buffi

DOI
https://doi.org/10.3390/medicina60030463
Journal volume & issue
Vol. 60, no. 3
p. 463

Abstract

Read online

Background and Objectives: to investigate the impact of age on renal function deterioration after robotic-assisted partial nephrectomy (RAPN) focusing on a decline to moderate and severe forms of chronic kidney disease (CKD). Materials and Methods: This is a single center prospective analysis of patients who underwent RAPN. The outcomes include the development of de novo CKD-S 3a [estimated glomerular filtration rate (eGFR) 2)] and de novo CKD-S 3b (eGFR 2). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S 3a/b. Kaplan –Meier Analyses (KMA) were fitted for survival assessment. Multivariable linear regression was utilized to identify the predictors of last-eGFR. Results: Overall, 258 patients were analyzed [low age (n = 40 (15.5%); intermediate age (50–70) n = 164 (63.5%); high age (>70) n = 54 (20.9%)] with a median follow-up of 31 (IQR 20–42) months. MVA revealed an increasing RENAL score [Hazard Ratio (HR) 1.32, p = 0.009], age 50–70 (HR 6.21, p = 0.01), age ≥ 70 (HR 10.81, p = 0.001), increasing BMI (HR 1.11, p p = 0.014) are independent risk factors associated with an increased risk of CKD-S 3a; conversely, post-surgical acute kidney injury was not (p = 0.83). MVA for CKD-S 3b revealed an increasing RENAL score (HR 1.51, p = 0.013) and age ≥ 70 (HR 2.73, p = 0.046) are associated with an increased risk of CKD-S 3b. Linear regression analysis revealed increasing age (Coeff. −0.76, p p = 0.03), and increasing BMI (Coeff. −0.64, p = 0.004) are associated with decreasing eGFR at last follow-up. We compare the survival distribution of our cohort stratified by age elderly patients experienced worsened CKD-S 3a/b disease-free survival (p p Conclusions: Age is independently associated with a greater risk of significant and ongoing decline in kidney function following RAPN. Recognizing the impact of aging on renal function post-surgery can guide better management practices. Further investigations are required.

Keywords