Partial Nephrectomy for Patients with Severe Chronic Kidney Disease-Is It Worthwhile?

Area of Science:

• Nephrology
• Urology
• Oncology

Background:

• Partial nephrectomy is preferred for kidney cancer in chronic kidney disease (CKD) patients.
• However, the risk of rapid progression to end-stage renal disease (ESRD) in severe CKD warrants re-evaluation.

Purpose of the Study:

• To evaluate outcomes of partial nephrectomy in patients with stage IV CKD.
• To identify factors associated with progression to ESRD after partial nephrectomy.

Main Methods:

• Retrospective review of 62 stage IV CKD patients undergoing partial nephrectomy (1999-2015).
• Analysis of preoperative/intraoperative factors and postoperative outcomes.
• Survival analysis for time-to-ESRD progression.

Main Results:

• 16% had benign pathology; 37% had high-grade tumors.
• 24% experienced unfavorable outcomes (mortality, major complications, positive margins).
• Median time to ESRD was 27 months, significantly shorter with lower preoperative eGFR. African American race, lower eGFR, and minimally invasive approach were associated with faster ESRD progression.

Conclusions:

• Partial nephrectomy in stage IV CKD patients can lead to unfavorable outcomes and rapid ESRD progression.
• Renal mass biopsy is recommended for better patient selection.
• Active surveillance or radical nephrectomy may be better for high-risk patients (African American, eGFR < 25 ml/min/1.73 m²).