CHRONIC kidney disease (CKD) risk increased after unilateral nephrectomy in patients with advanced age, diabetes mellitus, lower preoperative kidney function, and radical nephrectomy, according to a systematic review and meta-analysis of 26 cohort studies involving 13,321 patients. The findings highlighted several preoperative and surgical factors associated with incident CKD and may help inform risk assessment before surgery.
Key Predictors Identified
Researchers systematically searched four databases from inception until January 2026 to identify adult cohort studies involving patients with preserved preoperative kidney function, defined as an eGFR of at least 60 mL/min/1.73 m², who underwent unilateral nephrectomy. Study quality was assessed using the Newcastle Ottawa Scale, and pooled analyses were conducted using fixed or random effects models according to study characteristics. Subgroup analyses, leave one out sensitivity analyses, and publication bias assessments were also performed.
The analysis found that advanced age, male sex, diabetes mellitus, lower preoperative eGFR, higher preoperative serum creatinine, and radical nephrectomy were all significantly associated with an increased likelihood of developing CKD after surgery. Conversely, higher baseline eGFR was associated with a reduced risk.
For every one-year increase in age, the likelihood of postoperative CKD increased (adjusted odds ratio: 1.05; 95% CI: 1.03–1.08). Patients who underwent radical nephrectomy also had a substantially greater risk of CKD than those undergoing partial nephrectomy (adjusted odds ratio: 3.73; 95% CI: 2.27–6.13).
Sensitivity analyses supported the robustness of the findings, although publication bias was detected for certain variables included in the analysis.
Clinical Implications for Surgical Planning
The findings suggested that identifying patients at increased risk before surgery could support more individualised perioperative management. The authors concluded that careful preoperative risk assessment may help identify patients who would benefit from closer postoperative monitoring.
The analysis also suggested that nephron sparing surgery, when oncologically appropriate, may reduce the burden of CKD following unilateral nephrectomy. In addition, risk adapted follow up may help clinicians identify declining kidney function earlier and guide long term patient management after surgery.
Yan Y et al. Risk factors for incident chronic kidney disease following unilateral nephrectomy: a systematic review and meta-analysis. Sci Rep. 2026;DOI: 10.1038/s41598-026-64417-8.
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Author:
Josh Warren Lister
