Effect of postoperative change of body mass index on renal function after laparoscopic partial nephrectomy
Wasilijiang Wahafu1, Ma Xin2, Zhang Xu2, Li Hongzhao2Ding Qiang2, Guo Gang2, Shi Taoping2, Wang Baojun2
1.Department of Urology, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, China; 2.Department of Urology, PLA Military General Hospital of Beijing
Abstract： Objective To evaluate the effect of postoperative change of body mass index (BMI) on renal function after laparoscopic partial nephrectomy (LPN). Methods A retrospective analysis on 204 patients who had undergone LPN by the same laparoscopic surgeon (Xu Zhang) in different followup periods (90 patients in oneyear group, 66 in threeyear group, and 48 in fiveyear group) was performed. Patient demographics, tumor characteristics, operative outcomes, and renal functions were compared. Univariate and multivariate analyses were performed to show predicting factors for the change value of estimated glomerular filtration rates (eGFR). Results The patients were followed up for a median period of 17 months in the oneyear group, 41.5 months in threeyear group, and 65 months in the fiveyear group. There were no significant differences among the three groups with respect to patient demographics, tumor characteristics, and perioperative outcomes. Although there were no differences observed in follow〖CM(49〗up BMI (p=0.857), there were significant differences regarding BMI change value and ratio among the groups (p=0.008 and p=0.015). And there was a trend towards rising of BMI in the three groups (0.59, 0.67 and 0.86 kg/m2 respectively). The oneyear group had faster operative time (91.46±25.57) min, (p=〖ZK)〗0.010), shorter warm ischemia time (17.81±5.98) min, (p=0.027), and less estimated blood loss (30.5±28.86) mL, (p=0.021) than the other groups. Comparison of preoperative renal function did not show a statistically significan difference among the three groups for serum creatinine (sCr) and eGFR; however, these effects reached statistically significant difference in sCr (p= 0.012) and eGFR (p= 0.001) during followup period, and the change trend in eGFR more obvious than in sCr. The fiveyear group showed a statistically significant difference compared with oneyear/threeyear groups in the change value of BMI (p=0.012/p=0.041), sCr (both p<0.001) and eGFR (both p<0.001). Univariate analyses showed fiveyear group (p<0.001), age (p=0.003), BMI change value and ratio (p=0.026 and p=0.048), ageadjusted CCI (p=0.020), R.E.N.A.L. score (p=0.049), preoperative eGFR (p<0.001) and warm ischemia time (p=0.039) as statistically significant predictive factors for the eGFR change value. In contrast, multivariate analyses showed that only fiveyear group (p< 0.001), BMI change value (p=0.039) and preoperative eGFR (p<0.001) had a statistically significant predictive factor for the eGFR change value. Conclusions: The increase of BMI was associated with declines in kidney function in a cohort of LPN patients. Clinicians should vigilantly monitor and timely intervene in elevated body weight patients for evidence of early kidney function decline in the longterm followup after LPN.
瓦斯里江·瓦哈甫,马鑫,张旭,李宏召,丁强,郭刚,史涛坪,王保军. 腹腔镜肾部分切除术后体质指数变化对肾功能影响的分析[J]. 微创泌尿外科杂志, 2015, 4(4): 200-107.
Wasilijiang Wahafu, Ma Xin, Zhang Xu, Li Hongzhao2Ding Qiang, Guo Gang, Shi Taoping, Wang Baojun. Effect of postoperative change of body mass index on renal function after laparoscopic partial nephrectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(4): 200-107.
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