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Glomerular hyperfiltration is a predictor of adverse outcomes following major urologic oncology surgery

  • Urology - Original Paper
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Abstract

Purpose

Glomerular hyperfiltration (GHF) has been associated with cardiovascular disease and all-cause mortality. We aimed to evaluate whether preoperative GHF is associated with 30-day complications following major urologic oncology procedures.

Methods

We conducted a retrospective cohort study using subjects from the 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database who underwent prostatectomy, cystectomy, or nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Patients were classified as having either low, normal, or high eGFR based on the 5th and 95th percentiles of age- and sex-specific quintiles for eGFR. Using multivariable logistic regression, we evaluated GHF as an independent predictor of postoperative complications.

Results

A total of 120,013 patients were eligible for analysis, of which 1706 (1.4%) were identified as having GHF, with a median eGFR of 105.37 ml/min per 1.73 m2 (IQR 94.84–116.77). Compared to patients with normal eGFR, patients with GHF were older (68 years, [IQR 60–71], p < 0.001), had a lower BMI (27.52 kg/m2 [IQR 23.71–31.95], p < 0.001), and greater 5-item modified frailty index scores (≥ 1, 70.6%, p < 0.001). Multivariable logistic regression demonstrated that GHF was associated with greater odds of any complication (OR 1.23, 95% CI 1.08–1.40, p = 0.002), non-home discharge (OR 1.86, 95% CI 1.50–2.30, p < 0.001), and prolonged LOS (OR 1.33, 95% CI 1.18–1.51, p < 0.001).

Conclusion

GHF is associated with greater odds of 30-day complications following major urologic oncology surgery.

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Author information

Authors and Affiliations

  1. Department of Urology, University of Florida, Jacksonville, FL, USA

    Carlos Riveros, Ana M. Forero & K. C. Balaji

  2. Department of Urology, Creighton University, Omaha, NE, USA

    Victor Chalfant & Dane Klett

  3. Department of Urology, University of Florida, Gainesville, FL, USA

    Elizabeth Di Valerio & Michael W. Bacchus

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  1. Carlos Riveros
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  7. K. C. Balaji
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Contributions

CR: conceptualization; data curation; formal analysis; methodology; software; writing–original draft. VC: writing–Review and editing. EDV: writing—review and editing. MB: writing–review and editing. AF: writing–review and editing. DK: supervision. KCB: project administration; resources; supervision.

Corresponding author

Correspondence to Carlos Riveros.

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The authors have no conflicts of interest to disclose.

Ethics approval

This study was deemed exempt from ethics approval as the database used contains deidentified data.

Disclosure

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Riveros, C., Chalfant, V., Di Valerio, E. et al. Glomerular hyperfiltration is a predictor of adverse outcomes following major urologic oncology surgery. Int Urol Nephrol 55, 229–239 (2023). https://doi.org/10.1007/s11255-022-03400-4

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