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Incident CKD after Radical or Partial Nephrectomy.

John T Leppert1,2,3,4, Remy W Lamberts5, I-Chun Thomas5

  • 1Departments of Urology, jleppert@stanford.edu.

Journal of the American Society of Nephrology : JASN
|October 12, 2017
PubMed
Summary
This summary is machine-generated.

Partial nephrectomy significantly reduces the risk of chronic kidney disease (CKD) and mortality compared to radical nephrectomy in kidney cancer patients. Kidney function decline after surgery is mainly observed in the first year.

Keywords:
Nephrectomychronic kidney diseasekidney cancer

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Area of Science:

  • Nephrology
  • Urology
  • Oncology

Background:

  • The comparative effectiveness of partial nephrectomy versus radical nephrectomy in preserving kidney function post-treatment for kidney cancer remains incompletely understood.
  • Chronic kidney disease (CKD) is a significant concern following kidney cancer surgery, impacting long-term patient health.

Purpose of the Study:

  • To determine the risk of clinically significant CKD (stage 4 and higher) after radical or partial nephrectomy in a large cohort of US veterans treated for kidney cancer.
  • To compare the long-term kidney function outcomes and survival rates between patients undergoing partial nephrectomy versus radical nephrectomy.

Main Methods:

  • Retrospective analysis of kidney cancer patients treated between 2001-2013 within the Veterans Health Administration.
  • Utilized propensity score-matching to create comparable cohorts for partial and radical nephrectomy.
  • Assessed the incidence of CKD stage 4+ and CKD stage 3b+ based on estimated glomerular filtration rate (eGFR) and analyzed mortality risk.

Main Results:

  • Among patients with preoperative eGFR ≥30 ml/min/1.73 m², 7.9% developed CKD stage 4+; partial nephrectomy was associated with a significantly lower risk (HR, 0.34; 95% CI, 0.26-0.43) compared to radical nephrectomy.
  • For patients with normal/near-normal preoperative kidney function (eGFR ≥60 ml/min/1.73 m²), partial nephrectomy significantly reduced the risk of CKD stage 3b+ (HR, 0.15; 95% CI, 0.11-0.19).
  • Partial nephrectomy was also associated with a reduced risk of mortality (HR, 0.55; 95% CI, 0.49-0.62).

Conclusions:

  • Partial nephrectomy offers a significant survival benefit and markedly reduces the incidence of clinically significant CKD compared to radical nephrectomy.
  • Kidney function decline post-surgery primarily occurs within the first year and tends to stabilize thereafter.
  • These findings support partial nephrectomy as a preferred approach for kidney cancer treatment when feasible to preserve renal function and improve patient outcomes.