NEAUA - Is Peri-Renal Fat Thickness of the Contralateral Kidney as Measured on Pre-Operative Imaging Associated With Progression to Chronic Kidney Disease After Radical Nephrectomy?

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Is Peri-Renal Fat Thickness of the Contralateral Kidney as Measured on Pre-Operative Imaging Associated With Progression to Chronic Kidney Disease After Radical Nephrectomy?
Andrew Harper Williams, MD, Ankur Choksi, MD, Graham Kupsaw, BS, Gabriela Nieto Blanco, BS, Boris Gershman, MD, Peter Chang, MD, Andrew Wagner, MD.
BIDMC, Boston, MA, USA.

BACKGROUND: Peri-renal fat thickness (PRFT) has been associated with the development of chronic kidney disease (CKD) with metabolic disorders. The association of PRFT and the development of CKD in patients undergoing radical nephrectomy has not been explored. In this study, we analyzed whether greater PRFT on pre-operative imaging of the contralateral kidney is a predictor of CKD Stage 3a (CKD3A) following radical nephrectomy.
METHODS: Single institutional retrospective study identifying CKD-na�ve adults (≥18 years) who underwent radical nephrectomy for localized kidney cancer between 2007 and 2025 with at least 6 months of follow-up. PRFT was measured on the contralateral kidney, by summing the anterior, lateral, and posterior fat measurements at the mid-hilar axial slice on pre-operative scans. Receiver operating characteristic (ROC) curve was generated to determine the optimal PRFT cutoff value. Kaplan-Meier curves were generated to assess CKD3A-free survival. Cox proportional hazards regression analysis was performed to identify predictors of CKD3A at 10 years postoperatively.
RESULTS: Of the 609 patients who underwent radical nephrectomy, 343 were excluded due to existing CKD or insufficient follow up, with 266 meeting inclusion criteria. ROC curve identified a cutoff of 33mm (AUC = 0.63) by the Youden index. Using this cutoff, Kaplan-Meier curves with 95% confidence intervals were generated to model CKD3A-free survival. Multivariable cox regression at 10 years postoperatively revealed PRFT ≥ 33mm was associated with greater hazards of CKD3A (HR: 1.82, 95%CI: 1.11 - 3.02, p = 0.019) adjusting for age, sex, race, BMI, GFR, laterality, and history of diabetes, hypertension, and smoking.
CONCLUSIONS: Contralateral PRFT ≥33mm is associated with higher risk of CKD3A at 10 years following radical nephrectomy.

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