Early compensatory increase in single-kidney estimated GFR after unilateral nephrectomy is associated with a lower long-term risk of estimated GFR decline

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Abstract
Background and hypothesis: A more pronounced short-term increase in single-kidney GFR (ΔskGFR) has been associated with better long-term kidney function in living kidney donors. Whether this also applies to non-donors is unknown. We evaluated whether ΔskGFR is associated with long-term risk of eGFR decline in individuals undergoing unilateral nephrectomy. Methods: This study included 1777 participants from the SCREAM cohort who underwent radical unilateral nephrectomy in Stockholm between 2006 and 2021. The ΔskGFR was calculated as the early (1–6 months) post-nephrectomy eGFR minus 50% of the pre-nephrectomy eGFR. Multivariable Cox regression was used to study the association between Δsk-GFR and the subsequent risk of progressive eGFR decline, defined as composite of an eGFR decline >30% compared to the early (6 months) post-nephrectomy eGFR or kidney failure. Results: Mean age at nephrectomy was 68 ± 11 years, 40% were female, 92% had kidney cancer, and median (IQR) pre-nephrectomy eGFR was 76 (61–89) ml/min/1.73 m2. Median Δsk-GFR was 11 (7–20) ml/min/1.73 m2. Pre-nephrectomy determinants of Δsk-GFR were age (inverse association) and pre-nephrectomy eGFR (positive association). During a median follow-up of 5 years (range 0.6–15 years), 178 participants developed progressive eGFR decline. Individuals with a Δsk-GFR above the median had a lower rate of progressive eGFR decline (adjusted HR: 0.58, 95% CI: 0.42–0.80), compared to those with a Δsk-GFR below the median, independent of baseline eGFR and age. Conclusions: A stronger increase in single-kidney eGFR early after unilateral nephrectomy was associated with a lower long-term risk of progressive eGFR decline. Evaluation of Δsk-GFR could help identify patients at higher risk of progressive kidney function decline following unilateral nephrectomy.
Funding Information
  • NOW-VENI (09150162310058)
  • European Union (ERC-COG 101125516)
  • Swedish Research Council (2023-01807)
  • National Institutes of Health (R01DK115534)
  • Swedish Heart and Lung Foundation (20230371)
  • Region Stockholm (FoUI-986028)

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