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
Affiliations
Cesare Saitta
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Giuseppe Garofano
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Giovanni Lughezzani
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Margaret F. Meagher
Department of Urology, UC San Diego Health System, San Diego, CA 92037, USA
Kit L. Yuen
Department of Urology, UC San Diego Health System, San Diego, CA 92037, USA
Vittorio Fasulo
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Pietro Diana
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Alessandro Uleri
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Andrea Piccolini
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Stefano Mancon
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Paola Arena
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Federica Sordelli
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Matilde Mantovani
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Pier Paolo Avolio
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Edoardo Beatrici
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
Rodolfo F. Hurle
Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Massimo Lazzeri
Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Alberto Saita
Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Paolo Casale
Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Ithaar H. Derweesh
Department of Urology, UC San Diego Health System, San Diego, CA 92037, USA
Marco Paciotti
Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Nicolò M. Buffi
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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.
