Presentation Authors: Brittney Cotta*, San Diego, CA, Kazutaka Saito, Tokyo, Japan, Margaret Meagher, San Diego, CA, Dattatraya Patil, Atlanta, GA, Ahmed Eldefrawy, San Diego, CA, Yosuke Yosuda, Tokyo, Japan, Aaron Bradshaw, Stephen Ryan, David Anyakora, Addison Yee, Juliana Alksne, Fang Wan, San Diego, CA, Viraj Master, Atlanta, GA, Yasuhisa Fujii, Tokyo, Japan, Ithaar Derweesh, San Diego, CA
Introduction: C-reactive protein (CRP) is an inflammatory marker associated with cardiovascular outcomes in chronic kidney disease. We investigated association of pre-treatment CRP and renal functional outcomes in a cohort of patients undergoing surgery for renal cell carcinoma (RCC).
Methods: Retrospective multicenter analysis of patients surgically treated for RCC from 2006-17. Descriptive analyses were obtained between normal pre-treatment CRP (â‰¤0.5mg/L) and elevated CRP (>0.5mg/L) groups. Primary outcome was development of de novo estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73m2, by CKD-EPI equation. Multivariable analyses (MVA) and Kaplan-Meier Analyses (KMA) were utilized to delineate freedom from and predictors for eGFR < 60, < 45, and < 30.
Results: A total of 2,693 patients who underwent radical (RN) or partial nephrectomy (PN) were analyzed (normal-CRP n=1,198; elevated-CRP n=1,495, median follow-up 22 months). Groups were similar in age (normal-CRP 59 vs. elevated-CRP 60 years, p=0.163), and type of surgery (p=0.843). Elevated-CRP patients were more frequently African-American (20.9% vs. 2.8%, p < 0.001) with a larger median tumor size (6.1 cm vs. 4.0 cm, p < 0.001). On MVA elevated-CRP was independently associated with development of de novo eGFR < 60 (OR=2.56, p < 0.001), eGFR < 45 (OR=2.75, p < 0.001; Table) and eGFR < 30 (OR=1.98, p < 0.001). KMA revealed significantly higher 5 year freedom from de novo eGFR < 45 for normal-CRP as opposed to elevated-CRP (68.5% vs. 43.5%, log-rank p < 0.001, Figure).
Conclusions: Pre-treatment elevated CRP was independently associated with progressive renal functional decline in patients undergoing surgery for RCC in an international cohort. Our findings suggest consideration for close functional follow up and renoprotective strategies for patients with elevated CRP as well as employment of nephron-sparing management when feasible and appropriate.
Source of Funding: Stephen Weissman Kidney Cancer Research Fund