Body Composition May Be a Novel Presurgical Risk Factor for Acute Kidney Injury among Clear Cell Renal Cell Cancer Patients Undergoing Radical Nephrectomy
Main Article Content
Keywords
kidney cancer, visceral adipose tissue, muscle, body composition, acute kidney injury, kidney function
Abstract
Patients with renal cell carcinoma (RCC) undergoing nephrectomy are at risk for acute kidney injury (AKI). Prior studies have focused predominantly on nonmodifiable surgical AKI risk factors. We conducted the first investigation of body composition features and AKI to identify factors that could improve presurgical risk stratification and be targeted in future interventions. We analyzed data from 1199 patients with stages I–III, clear cell RCC undergoing radical (RN) or partial nephrectomy (PN) from 2000 to 2020. AKI was defined as a serum creatinine (sCr) increase by 0.3 mg/dL within 48 h or a 1.5-fold increase in sCr within 7 days. Preoperative computed tomography (CT) scans were segmented to determine quantities and radiodensities of adipose tissue and skeletal muscle using Automatica software. Multivariable generalized linear models estimated 7-day risk differences (RD) and 95% confidence intervals (CI) within surgical subgroups. AKI was more frequent among patients undergoing RN (66%) than PN (26%). For RN, only higher visceral adipose tissue (VAT) quantity was significantly associated with greater AKI risk (RD per 40-unit increase 5.2 [95% CI: 1.3, 9.2]). We initially detected a similar association in PN, but after multivariable adjustment for all body composition features, associations were attenuated and became nonsignificant. Associations between presurgical body composition and AKI risk vary by surgery type. Higher VAT quantity increased AKI risk only among RN patients. If confirmed, CT-derived VAT quantity may be a novel pre-surgical imaging characteristic that could be used to inform treatment selection or modified to decrease postoperative AKI risk in RN patients.
References
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21. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol. 2004;97(6):2333–8. https://doi.org/10.1152/japplphysiol.00744.2004
22. Shah RV, Murthy VL, Allison MA, Ding J, Budoff M, Frazier-Wood AC, et al. Diet and adipose tissue distributions: The Multi-Ethnic Study of Atherosclerosis. Nutr Metab Cardiovasc Dis. 2016;26(3):185–93. https://doi.org/10.1016/j.numecd.2015.12.012
23. Goodpaster BH, Kelley DE, Thaete FL, He J, Ross R. Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol (1985). 2000;89(1):104–10. https://doi.org/10.1152/jappl.2000.89.1.104
24. Bhullar SK, Nusier M, Shah AK, Dhalla NS. Role of molecular and metabolic defects in impaired performance of dystrophic skeletal muscles. J Mol Clin Med. 2021;4(2):47. https://doi.org/10.31083/j.jmcm0402005
25. Xu L, Li C, Zhao L, Zhou B, Luo C, Man X, et al. Acute kidney injury after nephrectomy: A new nomogram to predict postoperative renal function. BMC Nephrol. 2020;21(1):181. https://doi.org/10.1186/s12882-020-01839-0
26. Kovalchik S, Varadhan R. Fitting additive binomial regression models with the R package blm. J Stat Software. 2013;54(1):1–18. https://doi.org/10.18637/jss.v054.i01
27. Rothman KJ. Modern epidemiology. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.
28. Walach MT, Schiefelbein F, Schneller A, Schoen G, von Klot CAJ, Katzendorn O, et al. Perinephric toxic fat: Impact on surgical complexity, perioperative outcome, and surgical approach in partial nephrectomy. Urol Int. 2023;107(2):126–33. https://doi.org/10.1159/000527090
29. Grigoraș A, Balan RA, Căruntu ID, Giușcă SE, Lozneanu L, Avadanei RE, et al. Perirenal adipose tissue—Current knowledge and future opportunities. J Clin Med. 2021;10(6):1291. https://doi.org/10.3390/jcm10061291
30. Hammoud SH, AlZaim I, Al-Dhaheri Y, Eid AH, El-Yazbi AF. Perirenal adipose tissue inflammation: Novel insights linking metabolic dysfunction to renal diseases. Front Endocrinol (Lausanne). 2021;12:707126. https://doi.org/10.3389/fendo.2021.707126
31. Pereira-Manfro WF, de Lima GR, Nogueira Neto JF, Portugal MRC, Milagres LG, Bezerra FF, et al. Association between visceral/subcutaneous adipose tissue ratio and plasma inflammatory markers and score for cardiovascular risk prediction in a Brazilian cohort: Pró-saúde study. Braz J Med Biol Res. 2021;54(12):e11521. https://doi.org/10.1590/1414-431X2021e11521
32. Moreno Cortés JC, González García J, Caño Velasco J, Aragón Chamizo J, Subirá Rios D. Reconstruction techniques after partial nephrectomy: Classic vs. sutureless approach—A narrative review. Curr Urol Rep. 2024;25(2):49–54. https://doi.org/10.1007/s11934-023-01194-1
33. Shiff B, Breau RH, Patel P, Mallick R, Tanguay S, So A, et al. Impact of time to surgery and surgical delay on oncologic outcomes for renal cell carcinoma. J Urol. 2021;205(1):78–83. https://doi.org/10.1097/JU.0000000000001230
34. Liao C, Liang X, Zhang X, Li Y. The effects of GLP-1 receptor agonists on visceral fat and liver ectopic fat in an adult population with or without diabetes and nonalcoholic fatty liver disease: A systematic review and meta-analysis. PLoS One. 2023;18(8):e0289616. https://doi.org/10.1371/journal.pone.0289616
35. Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA Guideline: Part I. J Urol. 2021;206(2):199–208. https://doi.org/10.1097/JU.0000000000001911
36. Campbell SC, Uzzo RG, Karam JA, Chang SS, Clark PE, Souter L. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA Guideline: Part II. J Urol. 2021;206(2):209–18. https://doi.org/10.1097/JU.0000000000001912
2. Zabor EC, Furberg H, Mashni J, Lee B, Jaimes EA, Russo P. Factors associated with recovery of renal function following radical nephrectomy for kidney neoplasms. Clin J Am Soc Nephrol. 2016;11(1):101–7. https://doi.org/10.2215/CJN.04070415
3. Antonelli A, Allinovi M, Cocci A, Russo GI, Schiavina R, Rocco B, et al. The predictive role of biomarkers for the detection of acute kidney injury after partial or radical nephrectomy: A systematic review of the literature. Eur Urol Focus. 2020;6(2):344–53. https://doi.org/10.1016/j.euf.2018.09.020
4. Cho A, Lee JE, Kwon GY, Huh W, Lee HM, Kim YG, et al. Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol Dial Transplant. 2011;26(11):3496–501. https://doi.org/10.1093/ndt/gfr094
5. Campbell SC, Campbell JA, Munoz-Lopez C, Rathi N, Yasuda Y, Attawettayanon W. Every decade counts: A narrative review of functional recovery after partial nephrectomy. BJU Int. 2022;131(2):165–72. https://doi.org/10.1111/bju.15848
6. Huang WC, Donin NM, Levey AS, Campbell SC. Chronic kidney disease and kidney cancer surgery: New perspectives. J Urol. 2020;203(3):475–85. https://doi.org/10.1097/JU.0000000000000326
7. Liu X, Sun Q, Hou H, Zhu K, Wang Q, Liu H, et al. The association between BMI and kidney cancer risk: An updated dose-response meta-analysis in accordance with PRISMA guideline. Medicine (Baltimore). 2018;97(44):e12860. https://doi.org/10.1097/MD.0000000000012860
8. Nguyen A, Khafagy R, Gao Y, Meerasa A, Roshandel D, Anvari M, et al. Association between obesity and chronic kidney disease: Multivariable Mendelian randomization analysis and observational data from a bariatric surgery cohort. Diabetes. 2023;72(4):496–510. C10.2337/db22-0696
9. Kazama A, Attawettayanon W, Munoz-Lopez C, Rathi N, Lewis K, Maina E, et al. Parenchymal volume preservation during partial nephrectomy: Improved methodology to assess impact and predictive factors. BJU Int. 2024;134(2):219–28. https://doi.org/10.1111/bju.16300
10. Attawettayanon W, Yasuda Y, Zhang JH, Rathi N, Munoz-Lopez C, Kazama A, et al. Functional recovery after partial nephrectomy in a solitary kidney. Urol Oncol. 2024;42(2):32.e17–32.e27. https://doi.org/10.1016/j.urolonc.2023.12.004
11. Bray GA. Beyond BMI. Nutrients. 2023;15(10):2254. https://doi.org/10.3390/nu15102254
12. Bradshaw PT, Olsson LT, Sanchez A, Knezevic A, Akin O, Scott JM, et al. Radiodensities of skeletal muscle and visceral adipose tissues are prognostic factors in clear cell renal cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2024;33(10):1375–82. https://doi.org/10.1158/1055-9965
13. Vrieling A, Kampman E, Knijnenburg NC, Mulders PF, Michiel Sedelaar JP, Baracos VE, et al. Body composition in relation to clinical outcomes in renal cell cancer: A systematic review and meta-analysis. Eur Urol Focus. 2018;4(3):420–34. https://doi.org/10.1016/j.euf.2016.11.009
14. Chen X, Mao Y, Hu J, Han S, Gong L, Luo T, et al. Perirenal fat thickness is significantly associated with the risk for development of chronic kidney disease in patients with diabetes. Diabetes. 2021;70(10):2322–32. https://doi.org/10.2337/DB20-1031
15. Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. Am J Nephrol. 2017;45(3):283–91. https://doi.org/10.1159/000458467
16. Furberg H, Bradshaw PT, Knezevic A, Olsson L, Petruzella S, Stein E, et al. Skeletal muscle and visceral adipose radiodensities are pre-surgical, non-invasive markers of aggressive kidney cancer. J Cachexia Sarcopenia Muscle. 2024;15(2):726–34. https://doi.org/10.1002/jcsm.13429
17. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84. https://doi.org/10.1159/000339789
18. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
19. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089–100. https://doi.org/10.1111/j.1523-1755.2005.00365.x
20. Paris MT, Tandon P, Heyland DK, Furberg H, Premji T, Low G, et al. Automated body composition analysis of clinically acquired computed tomography scans using neural networks. Clin Nutr. 2020;39(10):3049–55. https://doi.org/10.1016/j.clnu.2020.01.008
21. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol. 2004;97(6):2333–8. https://doi.org/10.1152/japplphysiol.00744.2004
22. Shah RV, Murthy VL, Allison MA, Ding J, Budoff M, Frazier-Wood AC, et al. Diet and adipose tissue distributions: The Multi-Ethnic Study of Atherosclerosis. Nutr Metab Cardiovasc Dis. 2016;26(3):185–93. https://doi.org/10.1016/j.numecd.2015.12.012
23. Goodpaster BH, Kelley DE, Thaete FL, He J, Ross R. Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol (1985). 2000;89(1):104–10. https://doi.org/10.1152/jappl.2000.89.1.104
24. Bhullar SK, Nusier M, Shah AK, Dhalla NS. Role of molecular and metabolic defects in impaired performance of dystrophic skeletal muscles. J Mol Clin Med. 2021;4(2):47. https://doi.org/10.31083/j.jmcm0402005
25. Xu L, Li C, Zhao L, Zhou B, Luo C, Man X, et al. Acute kidney injury after nephrectomy: A new nomogram to predict postoperative renal function. BMC Nephrol. 2020;21(1):181. https://doi.org/10.1186/s12882-020-01839-0
26. Kovalchik S, Varadhan R. Fitting additive binomial regression models with the R package blm. J Stat Software. 2013;54(1):1–18. https://doi.org/10.18637/jss.v054.i01
27. Rothman KJ. Modern epidemiology. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.
28. Walach MT, Schiefelbein F, Schneller A, Schoen G, von Klot CAJ, Katzendorn O, et al. Perinephric toxic fat: Impact on surgical complexity, perioperative outcome, and surgical approach in partial nephrectomy. Urol Int. 2023;107(2):126–33. https://doi.org/10.1159/000527090
29. Grigoraș A, Balan RA, Căruntu ID, Giușcă SE, Lozneanu L, Avadanei RE, et al. Perirenal adipose tissue—Current knowledge and future opportunities. J Clin Med. 2021;10(6):1291. https://doi.org/10.3390/jcm10061291
30. Hammoud SH, AlZaim I, Al-Dhaheri Y, Eid AH, El-Yazbi AF. Perirenal adipose tissue inflammation: Novel insights linking metabolic dysfunction to renal diseases. Front Endocrinol (Lausanne). 2021;12:707126. https://doi.org/10.3389/fendo.2021.707126
31. Pereira-Manfro WF, de Lima GR, Nogueira Neto JF, Portugal MRC, Milagres LG, Bezerra FF, et al. Association between visceral/subcutaneous adipose tissue ratio and plasma inflammatory markers and score for cardiovascular risk prediction in a Brazilian cohort: Pró-saúde study. Braz J Med Biol Res. 2021;54(12):e11521. https://doi.org/10.1590/1414-431X2021e11521
32. Moreno Cortés JC, González García J, Caño Velasco J, Aragón Chamizo J, Subirá Rios D. Reconstruction techniques after partial nephrectomy: Classic vs. sutureless approach—A narrative review. Curr Urol Rep. 2024;25(2):49–54. https://doi.org/10.1007/s11934-023-01194-1
33. Shiff B, Breau RH, Patel P, Mallick R, Tanguay S, So A, et al. Impact of time to surgery and surgical delay on oncologic outcomes for renal cell carcinoma. J Urol. 2021;205(1):78–83. https://doi.org/10.1097/JU.0000000000001230
34. Liao C, Liang X, Zhang X, Li Y. The effects of GLP-1 receptor agonists on visceral fat and liver ectopic fat in an adult population with or without diabetes and nonalcoholic fatty liver disease: A systematic review and meta-analysis. PLoS One. 2023;18(8):e0289616. https://doi.org/10.1371/journal.pone.0289616
35. Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA Guideline: Part I. J Urol. 2021;206(2):199–208. https://doi.org/10.1097/JU.0000000000001911
36. Campbell SC, Uzzo RG, Karam JA, Chang SS, Clark PE, Souter L. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA Guideline: Part II. J Urol. 2021;206(2):209–18. https://doi.org/10.1097/JU.0000000000001912
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Oct 17, 2025
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Body Composition May Be a Novel Presurgical Risk Factor for Acute Kidney Injury among Clear Cell Renal Cell Cancer Patients Undergoing Radical Nephrectomy. (2025). Journal of Kidney Cancer, 12(4), 19-29. https://doi.org/10.15586/jkcvhl.v12i4.423
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Kidney Cancer: Original Articles
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How to Cite
Body Composition May Be a Novel Presurgical Risk Factor for Acute Kidney Injury among Clear Cell Renal Cell Cancer Patients Undergoing Radical Nephrectomy. (2025). Journal of Kidney Cancer, 12(4), 19-29. https://doi.org/10.15586/jkcvhl.v12i4.423