Elevated C-reactive protein levels prior to nephrectomy for renal cell carcinoma is associated with an increased risk of renal impairment, a study found. CHICAGO—Elevated C-reactive protein (CRP) levels prior to surgery for renal cell carcinoma (RCC) is associated with progressive renal function decline, according to study findings presented at the 2019 American Urological Association annual meeting.
The findings suggest consideration for close functional follow up and renoprotective strategies for patients with elevated CRP in addition to use of nephron-sparing management when feasible and appropriate, Brittney Cotta, MD, of the University of California, San Diego (UCSD), and colleagues concluded in a poster presentation.
Dr Cotta’s team studied 2445 patients who underwent partial or radical nephrectomy at UCSD, Tokyo Medical and Dental University in Japan, and Emory University in Atlanta. Prior to surgery, 1092 had normal CRP levels (0.5 mg/L or less) and 1353 had elevated levels (above 0.5 mg/L). CRP is an inflammatory marker associated with cardiovascular outcomes in patients with chronic kidney disease, the investigators noted.
The median follow-up was 22 months. The primary end point was development of de novo estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m 2 as measured using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
On multivariate analysis, pre-surgery elevated CRP was significantly associated with 2.7-fold increased odds of the primary end point and nearly 2-fold and 2.6-fold increased odds of de novo eGFR below 30 and 60 mL/min/1.73 m 2 , respectively, compared with normal pre-surgery CPR.
In addition, a significantly higher proportion of patients with normal CRP levels had 5-year freedom from de novo eGFR below 45 mL/min/1.73 m 2 compared with those who had elevated CRP (92% vs 56%).
Elevated CRP prior to surgery occurred in significantly more black patients than patients of other races (37.5% vs 2.8%) and in patients with than without coronary artery disease (13.6% vs 9.3%). Patients with elevated CRP also had larger tumors than those without elevated CRP (median 6.1 vs 4 cm).
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Cotta B, Saito K, Meagher M, et al. Elevated C-reactive protein is independently associated with progressive renal functional decline after surgery for renal cell carcinoma: Results of an international cohort study. Presented at the 2019 American Urological Association annual meeting held May-3-6 in Chicago. Abstract MP31-16.
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