| Literature DB >> 30845916 |
Jan Ebbing1,2, Felix Menzel3, Paolo Frumento4, Kurt Miller3, Bernhard Ralla3, Tom Florian Fuller3, Jonas Busch3, Justin William Collins5, Christofer Adding5, Hans Helge Seifert6, Peter Ardelt6, Christian Wetterauer6, Timm Westhoff7, Carsten Kempkensteffen3,8.
Abstract
Following publication.Entities:
Year: 2019 PMID: 30845916 PMCID: PMC6404321 DOI: 10.1186/s12882-019-1264-7
Source DB: PubMed Journal: BMC Nephrol ISSN: 1471-2369 Impact factor: 2.388
Fig. 1 Box plots showing the postoperative course of the absolute (a/c/e/g/i) and relative (b/d/f/h/j) change (%) in eGFR at measurement times A-E for (a/b) the overall NSS cohort (NSS-C), (c/d) the NSS group with intraoperative renal ischaemia (NSS-RI) and without intraoperative renal ischaemia (NSS-NRI), (e/f) the LNSS group with intraoperative renal ischaemia (LNSS-RI), the ONSS group with intraoperative renal ischaemia (ONSS-RI), (g/h) the NSS group with postoperative AKI (NSS-AKI), the NSS group without postoperative AKI (NSS-NAKI), and (i/j) NSS group with a baseline eGFR category G1 (NSS-G1), NSS group with a baseline eGFR category G2 (NSS-G2), and NSS group with a baseline eGFR category ≥G3 (NSS ≥ G3). Definition of measurement times a-e: (a) highest change in eGFR from baseline during the planned hospital stay at a median of 1 day postoperatively (IQR, 1–2), (b) change in eGFR from baseline prior to discharge from hospital at a median of 4 days postoperatively (IQR, 2–6), (c) change in eGFR from baseline at a median of 47 days postoperatively (IQR, 30–105), (d) a median of 13 months postoperatively (IQR, 12–15), and (e) a median of 50 months postoperatively (IQR, 35–81). Asterisks indicate significant changes from baseline in the level of absolute and relative changes in eGFR over the course of the observation period (Friedman’s test as a post hoc pairwise multiple comparison test) or between the compared groups at each measurement time (non-parametric Mann-Whitney U test). * p < 0.05, ** p < 0.01, *** p < 0.001, (ns) not significant. eGFR, estimated glomerular filtration rate; NSS, nephron-sparing surgery; LNSS, laparoscopic nephron-sparing surgery; ONSS, open nephronsparing surgery; AKI, acute kidney injury; IQR, interquartile range
Multiple regression analysis
| a (model 1) | Regression | Multiple linear regression | |
| Baseline eGFR (mL/ml/1.73 m22) | - 0.20 | - 0.38 - − 0.02 | 0.03 |
| Baseline Haemoglobin (mg/dL) | 0.51 | - 0.86 - 1.89 | 0.46 |
| Tumour diameter (cm) | 0.67 | - 0.43 - 1.76 | 0.24 |
| Tumour locus central (ref.) vs. peripheral | 0.43 | - 3.80 - 4.67 | 0.84 |
| Surgical approach LNSS (ref.) vs. ONSS | - 13.48 | - 17.65 - − 9.32 | < 0.001 |
| Sex male (ref.) vs. female | - 3.28 | - 7.80 - 1.25 | 0.16 |
| Age (years) | - 0.17 | - 0.36 - 0.01 | 0.06 |
| BMI (kg/m2) | - 0.88 | - 1.36 - − 0.41 | < 0.001 |
| Hypertension no (ref.) vs. yes | - 0.78 | - 4.75 - 3.18 | 0.70 |
| Ischaemia time (min) | - 0.27 | - 0.41 - − 0.13 | < 0.001 |
| Operative time (min) | - 0.06 | - 0.09 - − 0.03 | < 0.001 |
| Preoperative ureter stenting no (ref.) vs. yes | - 0.46 | - 5.64 - 4.71 | 0.86 |
| Intraoperative blood transfusions no (ref.) vs. yes | - 3.29 | - 11.91 - 5.33 | 0.45 |
| Postoperative complications no (ref.) vs. yes | - 3.36 | - 8.42 - 1.70 | 0.19 |
| Clavien-Dindo score < 3 (ref.) vs. ≥ 3 | - 10.98 | - 18.47 - − 3.48 | 0.004 |
| b (model 2) | Regression | Multiple linear regression | |
| Baseline eGFR (mL/ml/1.73 m22) | - 0.29 | - 0.49 - − 0.09 | 0.005 |
| Baseline Haemoglobin (mg/dL) | - 0.32 | - 1.95 - 1.31 | 0.70 |
| Relative change of eGFR from baseline at time A (%) | 0.18 | 0.03 - 0.33 | 0.02 |
| AKI 48 h p.o. no (ref.) vs. yes | - 2.11 | - 9.01 - 4.79 | 0.55 |
| Tumour diameter (cm) | - 1.76 | - 2.87 - − 0.66 | 0.002 |
| Tumour locus central (ref.) vs. peripheral | - 0.30 | - 5.14 - 4.54 | 0.90 |
| Surgical approach LNSS (ref.) vs. ONSS | 1.13 | - 4.17 - − 6.44 | 0.67 |
| Sex male (ref.) vs. female | 1.63 | - 3.43 - 6.70 | 0.53 |
| Age (years) | - 0.10 | - 0.33 - 0.13 | 0.40 |
| BMI (kg/m2) | 0.15 | - 0.39 - 0.70 | 0.58 |
| Hypertension no (ref.) vs. yes | - 2.11 | - 6.82 - 2.60 | 0.38 |
| Ischaemia time (min) | 0.03 | - 0.14 - 0.21 | 0.72 |
| Operative time (min) | 0.01 | - 0.03 - 0.05 | 0.54 |
| Preoperative ureter stenting no (ref.) vs. yes | - 4.35 | - 10.46 - 1.77 | 0.16 |
| Intraoperative blood transfusions no (ref.) vs. yes | 4.12 | - 6.29 - 14.52 | 0.44 |
| Postoperative complications no (ref.) vs. yes | 1.20 | - 4.77 - 7.18 | 0.69 |
| Clavien-Dindo score < 3 (ref.) vs. ≥ 3 | 4.43 | - 4.28 - 13.14 | 0.32 |
| c (model 3) | OR | Multiple logistic regression | |
| Baseline eGFR (mL/ml/1.73 m22) | 0.99 | 0.96 - 1.01 | 0.30 |
| Baseline Haemoglobin (mg/dl) | 0.85 | 0.70 - 1.03 | 0.10 |
| Tumour diameter (cm) | 0.94 | 0.81 - 1.08 | 0.35 |
| Tumour locus central (ref.) vs. peripheral | 1.20 | 0.70 - 2.05 | 0.51 |
| Surgical approach LNSS (ref.) vs. ONSS | 3.87 | 2.17 - 6.92 | < 0.001 |
| Sex male (ref.) vs. female | 2.51 | 1.35 - 4.67 | 0.004 |
| Age (years) | 1.01 | 0.99 - 1.04 | 0.26 |
| BMI (kg/m2) | 1.13 | 1.06 - 1.21 | < 0.001 |
| Hypertension no (ref.) vs. yes | 1.05 | 0.63 - 1.74 | 0.85 |
| Ischaemia time (min) | 1.02 | 1.00 - 1.04 | 0.046 |
| Operative time (min) | 1.01 | 1.00 - 1.01 | 0.002 |
| Preoperative ureter stenting no (ref.) vs. yes | 0.92 | 0.46 - 1.83 | 0.81 |
| Intraoperative blood transfusions no (ref.) vs. yes | 0.73 | 0.22 - 2.45 | 0.61 |
| Postoperative complications no (ref.) vs. yes | 1.79 | 0.92 - 3.48 | 0.08 |
| Clavien-Dindo score < 3 (ref.) vs. ≥ 3 | 2.14 | 0.68 - 6.72 | 0.19 |
| d (model 4) | OR | Multiple logistic regression | |
| Baseline eGFR (mL/ml/1.73 m2) | 0.89 | 0.85 - 0.92 | < 0.001 |
| Baseline Haemoglobin (mg/dL) | 0.99 | 0.73 - 1.35 | 0.95 |
| Relative change of eGFR from baseline at time A (%) | 0.98 | 0.98 - 1.01 | 0.12 |
| AKI 48 h p.o. no (ref.) vs. yes | 1.23 | 0.39 - 3.85 | 0.72 |
| Tumour diameter (cm) | 0.93 | 0.71 - 1.21 | 0.58 |
| Tumour locus central (ref.) vs. peripheral | 1.35 | 0.56 - 3.15 | 0.49 |
| Surgical approach LNSS (ref.) vs. ONSS | 1.69 | 0.67 - 4.24 | 0.26 |
| Sex male (ref.) vs. female | 0.63 | 0.24 - 1.67 | 0.35 |
| Age (years) | 0.99 | 0.95 - 1.04 | 0.75 |
| BMI (kg/m2) | 0.97 | 0.87 - 1.07 | 0.50 |
| Hypertension no (ref.) vs. yes | 1.62 | 0.66 - 4.00 | 0.29 |
| Ischaemia time (min) | 1.01 | 0.98 - 1.04 | 0.55 |
| Operative time (min) | 1.00 | 0.99 - 1.01 | 0.86 |
| Preoperative ureter stenting no (ref.) vs. yes | 1.26 | 0.41 - 3.86 | 0.68 |
| Intraoperative blood transfusions no (ref.) vs. yes | 0.95 | 0.08 - 11.05 | 0.97 |
| Postoperative complications no (ref.) vs. yes | 0.67 | 0.22 - 2.00 | 0.47 |
| Clavien-Dindo score < 3 (ref.) vs. ≥ 3 | 1.37 | 0.22 - 8.41 | 0.73 |
Multiple linear regression analysis for models 1 and 2 including ischaemia time as a continuous variable investigating predictors of the relative change (%) of eGFR from baseline at (a) measurement time A (median, 1 day p.o.; IQR, 1–2) and at (b) at measurement time D (median, 13 months p.o.; IQR 12–15), and multiple logistic regression analysis for models 3 and 4 including ischaemia time as a continuous variable investigating (c) predictors for the development of postoperative AKI within 48 h p.o. and (d) predictors for the development of postoperative new-onset CKD stage ≥ 3 (eGFR < 60 mL/min/1.73 m2) within measurement time D
The regression models are based on pooled estimates from 100 imputed datasets. A p-value < 0.05 is regarded as statistically significant
eGFR estimated glomerular filtration rate, CKD chronic kidney disease, AKI acute kidney injury, LNSS laparoscopic nephron-sparing surgery, ONSS open nephron-sparing surgery, BMI body mass index, OR odds ratio