Role of Clinical and Surgical Factors for the Prediction of Immediate, Early and Late Functional Results, and its Relationship with Cardiovascular Outcome after Partial Nephrectomy: Results from the Prospective Multicenter RECORd 1 Project

To determine the predictors of short and long-term renal function impairment after partial nephrectomy. MATERIALS AND METHODS: The clinical data of 769 consecutive patients submitted to partial nephrectomy were prospectively recorded in 19 urological Italian centers from 2009 to 2012 (RECORd1 Project). Of these, the clinical data of 708 patients alive, free from disease recurrence, and with a minimum 2-year functional follow-up were extracted. RESULTS: Patients underwent open (47.3%), laparoscopic (36,6%) or robot-assisted (16.1%) partial nephrectomy. Median baseline eGFR was 84.5 (interquartile range [IQR]: 69.9-99.1) ml/min/1.73m2. Immediate (3rd postoperative day), early (1th month) and late (24th month) renal function impairment >25% from baseline was identified in 25.3%, 21.6% and 14.8% of cases, respectively. Female gender and baseline eGFR were independent predictors of immediate, early and late RF impairment; age at diagnosis of immediate and late impairment; uncontrolled diabetes only to late impairment. Open and laparoscopic approaches and pedicle clamping were independent predictors of immediate and early renal function impairment. Overall 58/529 (11%) patients experienced postoperative cardiovascular events. Body mass index and late renal function impairment were independent predictors of postoperative cardiovascular events. CONCLUSIONS: Surgical modifiable factors were significantly associated with a worse immediate and early functional outcome after partial nephrectomy, while the clinical unmodifiable factors affected the renal function during the entire follow-up. Late renal function impairment is an independent predictor of development of postoperative cardiovascular events.