Background: Radical nephrectomy for renal cell carcinoma (RCC) is a risk factor for the development of chronic\nkidney disease (CKD), and the possibility of postoperative deterioration of renal function must be considered before\nsurgery. We investigated the contribution of the aortic calcification index (ACI) to the prediction of deterioration of\nrenal function in patients undergoing radical nephrectomy.\nMethods: Between January 1995 and December 2012, we performed 511 consecutive radical nephrectomies for\npatients with RCC. We retrospectively studied data from 109 patients who had regular postoperative follow-up of\nrenal function for at least five years. The patients were divided into non-CKD and pre-CKD based on a preoperative\nestimated glomerular filtration rate (eGFR) of �60 mL/min/1.73 m2 or <60 mL/min/1.73 m2, respectively. The ACI\nwas quantitatively measured by abdominal computed tomography before surgery. The patients in each group were\nstratified between low and high ACIs. Variables such as age, sex, comorbidities, and pre- and postoperative renal\nfunction were compared between patients with a low or high ACI in each group. Renal function deterioration-free\ninterval rates were evaluated by Kaplan-Meier analysis. Factors independently associated with deterioration of renal\nfunction were determined using multivariate analysis.\nResults: The median age, preoperative eGFR, and ACI in this cohort were 65 years, 68 mL/min/1.73 m2, and 8.3%,\nrespectively. Higher ACI (�8.3%) was significantly associated with eGFR decline in both non-CKD and pre-CKD\ngroups. Renal function deterioration-free interval rates were significantly lower in the ACI-high than ACI-low strata\nin both of the non-CKD and pre-CKD groups. Multivariate analysis showed that higher ACI was an independent risk\nfactor for deterioration of renal function at 5 years after radical nephrectomy.\nConclusions: Aortic calcification burden is a potential predictor of deterioration of renal function after radical\nnephrectomy.
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