Progression of Chronic Kidney Disease Following Radical and Partial Nephrectomy

• DOI: 10.1016/j.urology.2022.07.009
• Publication Date: 2022-07-22T06:00:14Z
• Authors: Cameron J. Britton; Vidit Sharma; Christine M. Lohse; John C. Lieske; Paige E. Nichols; Abhinav Khanna; John C. Cheville; Stephen A. Boorjian; Bradley C. Leibovich; R. Houston Thompson; Aaron M. Potretzke
• Keywords: Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Renal Insufficiency, Chronic; Carcinoma, Renal Cell; Nephrectomy; Kidney Neoplasms; Retrospective Studies; Glomerular Filtration Rate

To compare renal functional outcomes, as determined by percent decline in estimated glomerular filtration rate (eGFR) and CKD stage progression following radical (RN) and partial nephrectomy (PN) stratified by preoperative CKD stage.We retrospectively evaluated adults treated with RN or PN between 1980 and 2018 for unilateral, sporadic, solid renal masses. Multivariable linear models for percent change in eGFR (n = 3046) and competing-risk Cox proportional hazards models for increase in CKD staging (n = 5805) were used to determine if there was a significant interaction between type of surgery (RN vs PN) and preoperative CKD stage.Percent change in eGFR at 1 year was significantly worse for RN (n = 1724; 57%) compared with PN (n = 1322; 43%) for all preoperative CKD stages. RN (n = 3227; 56%) was more likely to result in CKD stage progression compared with PN (n = 2578; 44%) for preoperative CKD stages I-IIIb (P <.001) but not for CKD stage IV (P = .8).RN was more likely to result in decline in eGFR and CKD stage progression compared to PN for patients with preoperative CKD stage IIIb or less. Additionally, RN was associated with a significantly greater decline in eGFR at 1 year relative to PN in the CKD stage IV subset. Our data support performing PN for renal preservation when feasible.