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Kidney function decline in cT1a patients treated with Microwave Ablation versus Partial Nephrectomy
Jessica Qiu1, Guofen Yan2, Aisha Kazeem3
1University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA 22903.
Background:
Microwave ablation (MWA) is an emerging treatment modality for clinical T1a (cT1a) small renal masses (SRM) with studies showing it has comparable oncological outcomes to partial nephrectomy (PN). However, more research is needed to the impact of each treatment on kidney function decline.
Objective:
To compare the progression of kidney function decline in patients with cT1a SRM treated with MWA or PN.
Methods:
This study included prospective data on patients treated between 2015-2021 with kidney function data collected from 2015-2024 from a single institutional database. Three outcomes for kidney function decline were examined: 30% decline in estimated glomerular filtration rate (eGFR) compared to pre-treatment, chronic kidney disease (CKD) upstaging compared to pre-treatment and eGFR <60 mL/min/1.73m2, and the composite endpoint of the previous two events. Cox proportional hazards models were used to compare outcomes between the two treatments.
Results:
Among 97 MWA and 49 PN included, MWA patients were older, had lower baseline eGFR, and higher rates of CKD prior to treatment. Univariate Cox proportional hazard model showed treatment modality was not significantly associated with reaching kidney decline endpoints. After adjusting for patient characteristics (age, race, baseline eGFR, Charlson Comorbidity Index), only baseline eGFR was associated with reaching kidney function endpoints.
Conclusion:
There was no statistically significant difference in kidney function decline between PN and MWA treatments for cT1a SRM. After adjusting for patient factors, the higher hazard for MWA was attenuated.
Insights
Partial nephrectomy (PN) and microwave ablation (MWA) show similar kidney function decline for small renal masses. Baseline kidney function, not treatment type, significantly impacts outcomes after these procedures.
Area of Science:
- Nephrology
- Urology
- Oncology
Background:
- Microwave ablation (MWA) is an emerging treatment for small renal masses (SRM), with oncological outcomes comparable to partial nephrectomy (PN).
- Further research is needed to understand the comparative impact of MWA and PN on kidney function decline in patients with clinical T1a (cT1a) SRM.
Purpose of the Study:
- To compare the progression of kidney function decline in patients with cT1a SRM treated with either MWA or PN.
- To analyze differences in estimated glomerular filtration rate (eGFR) changes, chronic kidney disease (CKD) upstaging, and composite endpoints between the two treatment groups.
Main Methods:
- Prospective data from 2015-2021 were analyzed, with kidney function data collected through 2024 from a single institution.
- Kidney function decline was assessed by a 30% drop in eGFR, CKD upstaging, and a composite endpoint, using Cox proportional hazards models.
Main Results:
- The study included 97 MWA and 49 PN patients. MWA patients were older with lower baseline eGFR and higher pre-treatment CKD rates.
- Univariate analysis showed no significant association between treatment modality and kidney function decline endpoints.
- After adjusting for patient factors, only baseline eGFR remained significantly associated with kidney function decline.
Conclusions:
- No statistically significant difference in kidney function decline was observed between PN and MWA for cT1a SRM.
- Adjusting for patient characteristics attenuated the initial observed higher hazard for MWA, highlighting the importance of baseline factors.
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