Is Peri-Renal Fat Thickness Associated With Progression to Chronic Kidney Disease After Radical Nephrectomy?

Authors

Ankur Choksi, Andrew Williams, Gabriela Nieto Blanco, Graham Kupsaw, Sarah Duncan, Boris Gershman, Peter Chang, Andrew A Wagner

Published in

Clinical genitourinary cancer. Pages 102693. Oct 08, 2026. Epub Oct 08, 2026.

Abstract

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 associated with the development of CKD Stage 3a (CKD3A) following radical nephrectomy.
Using our institutional database, we identified CKD-naïve adults (≥18 years) who underwent radical nephrectomy for localized kidney cancer between 2007 and 2025 with at least 6 months of follow-up. Demographic and clinical data were abstracted from the database. 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.
Of the 609 patients who underwent radical nephrectomy, 343 were excluded due to existing CKD or insufficient follow up. In our study sample of 266 patients, 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 (Figure 1). Multivariable cox regression revealed PRFT ≥ 33mm was associated with 1.77 times greater 10-year hazards of CKD3A (CI: 1.07-2.93, P = .025) adjusting for age, sex, race, BMI, GFR, laterality, and history of diabetes, hypertension, and smoking.
A contralateral PRFT ≥ 33mm, which was an exploratory cohort derived threshold, was associated with higher risk of CKD3A at 10 years following radical nephrectomy.

PMID:
42966681
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.

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