Work

Renal Outcomes With Renin-Angiotensin System Blockers After Unilateral Nephrectomy

Year: 2024

Type: article

Abstract: Introduction Despite the benefits of renin-angiotensin system (RAS) blockers, their immediate use after nephrectomy has been limited because of concerns about impaired renal adaptation. We aimed to evaluate the effect of RAS blockers immediately following unilateral nephrectomy on renal adaptation. Methods This single-center retrospective cohort study included 580 patients who underwent elective unilateral nephrectomy between 2010 and 2020 and had pre-existing hypertension with antihypertensive medications. Patients were divided into groups according to the post-nephrectomy RAS blocker use. The primary outcome was renal adaptation defined as post-nephrectomy estimated glomerular filtration rate (eGFR) / pre-nephrectomy eGFR × 100 at 1 month after surgery. Secondary outcomes included hyperkalemia during the first year and mortality or end-stage kidney disease within three years. Results The mean age was 65.2 years, 406 (70%) were male, and 308 (53.1%) received RAS blockers after nephrectomy. The RAS blocker group was younger (63.8 vs 66.8 years) and had a higher eGFR (79.4 vs 75.5 ml/min/1.73 m 2 ) than the control group. There were no differences between the groups in renal adaptation at one month (67.1% vs. 66.8%, P = 0.711) or in the incidence of hyperkalemia until one year postoperatively. The RAS blocker use was associated with better dialysis-free survival [Adjusted hazard ratio of multivariable Cox-regression model, 0.531; 95% confidence interval, 0.329-0.857; P = 0.010]. Conclusion The immediate use of RAS blockers after unilateral nephrectomy did not deteriorate renal adaptation or increase hyperkalemia. Furthermore, the RAS blockers was associated with improved prognosis in terms of end-stage kidney disease and mortality.

Source: Kidney International Reports

DOI: 10.1016/j.ekir.2024.09.022