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Published on: July 3, 2013
Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis
Maxine Sun1, Marco Bianchi, Jens Hansen
1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. mcw.sun@umontreal.ca
Context:
Chronic kidney disease (CKD) is a worldwide health threat associated with increased cardiovascular disease and mortality.
Objective:
To examine postoperative CKD in patients with small renal masses (SRMs) treated with partial nephrectomy (PN) or radical nephrectomy (RN).
Design, Setting, And Participants:
A US National Cancer Institute Surveillance Epidemiology and End Results (SEER)-Medicare-linked retrospective cohort of 4633 T1aN0M0 renal cell carcinoma (RCC) patients who underwent PN or RN.
Outcome Measurements And Statistical Analysis:
The primary outcome of interest was the onset of CKD stage ≥3. Secondary end points comprised acute renal failure (ARF), chronic renal insufficiency (CRI), anemia in CKD, and end-stage renal disease (ESRD). Kaplan-Meier and Cox regression analyses were performed.
Results And Limitations:
Postpropensity matching resulted in 840 RN and PN patients. In multivariable analyses, RN patients were 1.9-, 1.4-, 1.8-, and 1.8-fold more likely to have an occurrence of CKD, ARF, CRI, and anemia in CKD, respectively (all p ≤ 0.004). The risk of ESRD between treatment groups failed to achieve statistical significance (p=0.06).
Conclusions:
PN is associated with more favorable postoperative renal function outcomes relative to RN in the setting of SRMs.
Insights
Partial nephrectomy (PN) offers better kidney function after surgery for small renal masses compared to radical nephrectomy (RN). RN increases risks of chronic kidney disease (CKD) and related complications.
Area of Science:
- Nephrology
- Urology
- Oncology
Background:
- Chronic kidney disease (CKD) poses a significant global health risk, linked to heightened cardiovascular disease and mortality.
- Small renal masses (SRMs) are increasingly detected, necessitating surgical intervention.
Purpose of the Study:
- To compare the incidence of postoperative chronic kidney disease (CKD) in patients with small renal masses (SRMs) treated with either partial nephrectomy (PN) or radical nephrectomy (RN).
Main Methods:
- Retrospective analysis of a US National Cancer Institute SEER-Medicare-linked cohort.
- Inclusion of 4633 patients with T1aN0M0 renal cell carcinoma (RCC) who underwent either PN or RN.
- Propensity score matching to create comparable groups for analysis.
Main Results:
- After propensity matching, 840 patients (420 in each group) were analyzed.
- Radical nephrectomy (RN) was associated with significantly higher odds of developing CKD (OR 1.9), acute renal failure (ARF) (OR 1.4), chronic renal insufficiency (CRI) (OR 1.8), and anemia in CKD (OR 1.8) compared to partial nephrectomy (PN).
- No statistically significant difference in the risk of end-stage renal disease (ESRD) was observed between the PN and RN groups (p=0.06).
Conclusions:
- Partial nephrectomy (PN) demonstrates superior postoperative renal function outcomes compared to radical nephrectomy (RN) for patients with small renal masses (SRMs).
- These findings support PN as the preferred surgical approach for preserving renal function in managing SRMs.
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