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Minerva Urology and Nephrology 2021 December;73(6):789-95

DOI: 10.23736/S2724-6051.21.04096-9


language: English

The impact of visceral adipose tissue on postoperative renal function after radical nephrectomy for renal cell carcinoma

Alberto OLIVERO 1 , Luca BASSO 2, Emanuele BARABINO 2, Paolo MILINTENDA 1, Nicolò TESTINO 1, Francesco CHIERIGO 1, Paolo DELL’OGLIO 3, Carlo E. NEUMAIER 4, Nazareno SUARDI 1, Carlo TERRONE 1

1 Department of Urology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy; 2 Department of Radiology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy; 3 Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 4 Department of Diagnostic Imaging and Senology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy

BACKGROUND: The objective of this study was to evaluate the usefulness of pre-operative visceral (VAT) and subcutaneous adipose tissue (SAT) evaluation in the prediction of acute kidney injury (AKI) and decrease of eGFR at 12 months after radical nephrectomy (RN).
METHODS: We relied on 112 patients who underwent RN between January 2010 and March 2017 at a single institution. Images from the pre-operatory CT scan were analyzed and both SAT and VAT assessments were carried out on a cross-sectional plane. eGFR was measured before surgery, at 7 days, and 12 months after surgery. ROC analysis was used to compare the diagnostic value of BMI, VAT ratio, and abdominal circumference in predicting AKI. Logistic regression models were fitted to predict the new onset of AKI, and the progression from chronic kidney disease (CKD) stage 1-3a to CKD stage 3b or from 3b to 4 at 12 months follow-up. Two logistic regression models were also performed to assess the predictors for AKI and CKD stage progression. The predictive accuracy was quantified using the receiver operating characteristic-derived area under the curve.
RESULTS: Sixty-six patients (58.9%) had AKI after RN. Thirty-five (31.3%) patients were upgraded to CKD IIIb or from CKD stage IIIb to CKD IV. In the ROC analysis, VAT% performed better than the BMI and abdominal circumference (AUC=0.66 vs. 0.49 and 0.54, respectively). At multivariable analyses, VAT reached an independent predictor status for AKI (OR: 1.03) and for CKD stage at 12-month follow-up (OR: 1.05). Inclusion of VAT% into the multivariable models was associated with the highest accuracy both for AKI (AUC=0.700 vs. 0.570) and CKD stage progression (AUC=0.848 vs. 0.800).
CONCLUSIONS: In patients undergoing RN, preoperative visceral adipose tissue ratio significantly predicts AKI incidence and is significantly predictive of 12-month CKD stage worsening.

KEY WORDS: Renal cell carcinoma; Acute kidney injury; Nephrectomy; Subcutaneous fat; Intra-abdominal fat

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