Abstract
Purpose
We analyzed trends related to surgical approach for renal cell carcinoma (RCC), including partial nephrectomy (PN) or radical nephrectomy (RN), in patients with stage 4 chronic kidney disease (CKD), and identified predictors for postoperative progression to end-stage renal disease (ESRD) requiring permanent dialysis.
Methods
We enrolled patients with stage 4 CKD who underwent surgery for non-metastatic RCC. We compared their characteristics according to surgical approach (PN vs. RN). Moreover, predictors for postoperative progression to requiring permanent dialysis were determined using multivariable analyses. The Charlson comorbidity index (CCI) was adjusted for age.
Results
Fifty-one patients (PN 23, RN 28) were evaluated in the present study. Their mean preoperative estimated glomerular filtration rate (eGFR) was 24 ml/min/1.73 m2, and four patients had a solitary kidney. Three of 23 patients (13 %) who underwent PN progressed to requiring dialysis after surgery after a median 16 months. In contrast, 13 of 28 patients (46 %) who underwent RN developed dialysis immediately after surgery (median 2 days). Patients who underwent PN had lower T stages (T1, PN 100 % vs. RN 50 %, p = 0.004) and smaller tumors (31 mm vs. 65 mm, p < 0.0001) than did those who underwent RN. RN and lower preoperative eGFR significantly predicted progression to requiring dialysis, while tumor size and CCI did not.
Conclusions
PN tended to be selected for patients with lower T stage and smaller tumors in the limited cohort of stage 4 CKD patients. PN had a significant benefit of preventing dialysis in the multivariable analysis.
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Abbreviations
- BMI:
-
Body mass index
- CCI:
-
Charlson comorbidity index
- CKD:
-
Chronic kidney disease
- eGFR:
-
Estimated glomerular filtration rate
- ESRD:
-
End-stage renal disease
- HR:
-
Hazard ratio
- PLOS:
-
Postoperative length of stay
- PN:
-
Partial nephrectomy
- RCC:
-
Renal cell carcinoma
- RN:
-
Radical nephrectomy
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Takagi, T., Kondo, T., Omae, K. et al. Comparison of progression to end-stage renal disease requiring dialysis after partial or radical nephrectomy for renal cell carcinoma in patients with severe chronic kidney disease. Int Urol Nephrol 48, 1421–1427 (2016). https://doi.org/10.1007/s11255-016-1317-9
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DOI: https://doi.org/10.1007/s11255-016-1317-9