To identify the risk factors associated with development of postoperative elevation of creatine kinase (CK) and study its effect on renal function in patients who underwent complex multifocal partial nephrectomy (PN).
Patients who underwent PN at National Cancer Institute between January 2007 and December 2012 were included in the study. Elevated serum CK was defined as >2000 U/L. Kidney function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR). Changes were reported as percent change from preoperative values and compared using the Wilcoxon test. Regression analysis was performed to identify the predictors of elevation in CK and decline in eGFR.
From 407 total cases, 207 had adequate CK data for analysis. Median number of tumors removed was 3 (1–70). Median peak CK was 1458 (82–36,788). Forty-two percent developed CK elevation >2000 U/L. Factors associated with postoperative elevation of CK > 2000 were young age (p = 0.009), high BMI (p = 0.003) and operating room time (p < 0.001). Although CK > 2000 was associated with significantly greater decline in eGFR (37.4 vs. 20.3 %, p < 0.001) in immediate postoperative period, this change largely resolved to a much less clinically relevant (9.2 vs 3.3 %, p = 0.040) change after 3 months. On multivariate analysis, postoperative elevation in CK was not found to be an independent factor determining renal function at 3 months.
In our cohort, a significant proportion of patients developed CK elevations >2000 U/L. While patients with elevated CK had more decline in eGFR in immediate postoperative period, postoperative elevations of CK did not appear to impact overall long-term renal function in patients undergoing PN.
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This research was supported in part by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research.
A.S. and A.W.D. wrote the manuscript; A.W.D., H.T. and N.M. acquired the data; M.M.S. and J.S. analyzed the data; G.B., W.M.L. and A.R.M. reviewed the manuscript; and A.R.M. designed the research.
Conflict of interest
Research involving human participants
All patients analyzed in the study were enrolled on various institutional review board-approved protocols. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all the patients at the time of enrollment on various institutional review board-approved protocols. For this retrospective study, a separate consent was not obtained.
Abhinav Sidana and Annerleim Walton-Diaz have contributed equally to the manuscript.
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Sidana, A., Walton-Diaz, A., Truong, H. et al. Postoperative elevation in creatine kinase and its impact on renal function in patients undergoing complex partial nephrectomy. Int Urol Nephrol 48, 1047–1053 (2016). https://doi.org/10.1007/s11255-016-1284-1
- Partial nephrectomy
- Creatine kinase
- Renal cell cancer