Comparative analysis of mortality and progression to end-stage renal disease between surgically induced and medical...

We aimed to compare the mortality rate and the risk for progression to end-stage renal disease (ESRD) and cardiovascular disease (CVD) between patients who underwent surgery for localized renal cell carcinoma (RCC) and those with chronic kidney disease (CKD) without surgery by investigating the National Health Insurance Service.

The surgical group (CKD-S) included patients who underwent radical or partial nephrectomy for RCC from 2007 to 2009. Grades of surgical CKD were classified according to the estimated glomerular filtration rate (eGFR) measured at a health screening within 2 years after surgery. The nonsurgical group (CKD-M) was graded according to the eGFR in the 2009-2010 health screenings. We performed 1:5 propensity score matching for age, gender, diabetes, hypertension, Charlson comorbidity index, smoking, alcohol consumption, baseline eGFR, and body mass index.

A total of 8,698 patients (CKD-S, n=1,521; CKD-M, n=7,177) were analyzed. The CKD-M group was at higher risk for progression to ESRD (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.04-3.44, p=0.036) and CVD (HR 1.17, 95% CI 1.06-1.29, p=0.002) than the CKD-S group. In the group of patients with grade 3 disease or higher, the CKD-M group was at significantly higher risk for progression to ESRD (HR 2.21, 95% CI 1.47-3.31, p<0.001), CVD (HR 1.32, 95% CI 1.20-1.45, p<0.001), and overall mortality (HR 1.50, 95% CI 1.21-1.86, p<0.001).

The risk for progression to ESRD, CVD, or mortality in patients with CKD-S may be lower than in patients with CKD-M.