PD56-04: Assessment of changes in arterial blood pressure after nephrectomy for kidney cancer VAPANCR (UroCCR 26)_Prospective Study

Pierre Bigot*, ANGERS, France, Jean-Christophe Bernhard, BORDEAUX, France, Nicolas Doumerc, François-Xavier Nouhaud, TOULOUSE, France, Idir Ouzaid, PARIS, France, Patrick Saulnier, ANGERS, France, Arnaud Mejean, Morgan Rouprêt, PARIS, France, Karim Bensalah, RENNES, France

Introduction: Kidney is an essential regulator of arterial blood pressure (ABP) via the renin-angiotensin system. The impact of kidney surgery on ABP is debated. Our objective was to evaluate the consequences of kidney surgery for cancer on ABP

Methods: We carried out a multicenter prospective study (NCT03218319) and included 200 patients who underwent nephrectomy for cancer between January 2018 and September 2020 at 7 academic centers from the UROCCR network. The study obtained approval from Ethical Committee (2017-A00127-46). Inclusions criteria were a localized cancer eligible to nephrectomy and the absence of pre-existing hypertension. ABP was monitored according to the recommendations for home blood pressure measurement. Four measurements were taken after 5 minutes of sitting rest, before breakfast and four additional measurements were taken in the evening before bedtime. Measurements were done during three consecutive days (average of 18 values). ABP evaluation was done the week before nephrectomy, one month and six months after nephrectomy. A renin assessment was done one week before surgery and 6 months after surgery. The primary endpoint was the occurrence of a clinically significant change in ABP at 6 months. A change in ABP was considered clinically significant if the variation in systolic and / or diastolic ABP was = 5 mmHg or if medical anti-hypertensive treatment was required.

Results: ABP and renin measurements were evaluable for 182 (91%) and 136 (68%) patients, respectively. There were 112 males and 88 females with a median age of 54 years. Radical (RN) and Partial nephrectomy (PN) were performed in 42 (21%) and 158 (79%) patients, respectively. At 6 months, 55 (30.2%) patients had a significant increase in their ABP and 12 (6.5%) patients started an antihypertensive treatment.  Type of surgery was not associated with increases in ABP (31.6 % PN vs 25% RN; p=0.559) nor prescription of antihypertensive drug (4.79%  PN vs 12.5 % RN; p=0.089). At 6 months, renin was not significantly higher than before surgery (16.098 vs 15.231, p=0.686). In multivariable analysis, type of surgery, age, sex, BMI, smoking, diabetes and dyslipidemia were not associated with significant changes in ABP.

Conclusions: Renal surgery for cancer induces significant variations in ABP in 30% of patients . Type of surgery is not associated with ABP outcomes. ABP after surgery seems not be related to renin secretion. Longer follow-up and additional patients will be necessary to determine whether this rise in ABP can have a consequence on the occurrence of cardio-vascular events.

Source of Funding: This study was granted by the French Association of Urology (AFU)