Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis

Eur Urol. 2012 Oct;62(4):696-703. doi: 10.1016/j.eururo.2012.03.051. Epub 2012 Mar 31.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anemia / etiology
  • Carcinoma, Renal Cell / surgery
  • Female
  • Humans
  • Kidney Neoplasms / surgery
  • Male
  • Nephrectomy / adverse effects*
  • Nephrectomy / methods
  • Postoperative Complications / etiology
  • Renal Insufficiency, Chronic / etiology*
  • Retrospective Studies
  • Risk
  • SEER Program
  • Treatment Outcome