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Should partial nephrectomy be considered “elective” in patients with stage 2 chronic kidney disease? A comparative analysis of functional and survival outcomes after radical and partial nephrectomy

  • Zachary A. Hamilton
  • Umberto Capitanio
  • Brian R. Lane
  • Alessandro Larcher
  • Kendrick Yim
  • Sumi Dey
  • Brittney H. Cotta
  • Margaret F. Meagher
  • Samer Kirmiz
  • Adam Bezinque
  • Ahmed Eldefrawy
  • Aaron Bradshaw
  • Stephen Ryan
  • Cristina Carenzi
  • Fang Wan
  • James Proudfoot
  • Francesco Montorsi
  • Ithaar H. DerweeshEmail author
Original Article

Abstract

Purpose

To compare renal function and survival outcomes in patients with baseline chronic kidney disease (CKD) stage 2 undergoing partial (PN) or radical nephrectomy (RN), as nephron-sparing surgery is considered to be elective in this group.

Methods

Retrospective analysis of patients with CKD stage 2 and T1/T2 renal mass undergoing PN or RN from 2001 to 2015. Patients were stratified into substage CKD 2a or CKD 2b and analyzed between types of surgery. Primary outcome was overall survival (OS), eGFR < 45 at last follow-up was the secondary outcome. Multivariable analysis (MVA) was conducted for predictors of eGFR < 45 and OS. Kaplan–Meier analyses were conducted for freedom from eGFR < 45 and OS.

Results

1213 patients analyzed (CKD 2a 609/CKD 2b 604) on MVA, RN (OR 3.68, p = 0.001) and CKD 2b (OR 3.3, p = 0.002) were independently associated with development of eGFR < 45 at last follow-up and RN (OR 3.76, p = 0.005) and eGFR < 45 (OR 2.51, p = 0.029) were associated with decreased OS. Kaplan–Meier analyses revealed that patients with CKD 2a/PN had the highest 5-year freedom from eGFR < 45 (94.3%) compared to CKD 2a/RN patients (91.5%), CKD2b/PN patients (87.6%) and CKD 2b/RN patients 82.0% (p < 0.001). Kaplan–Meier analyses for OS demonstrated that patients with CKD 2a/PN had significantly greater 5-year OS (97.6%) compared to CKD 2a/RN patients (95.2%), CKD 2b/PN patients (93.2%), and CKD 2b/RN patients (92.4%, p = 0.043).

Conclusions

Patients with baseline CKD stage 2, particularly CKD 2b and undergoing RN, are at increased risk of GFR < 45, which was associated with decreased OS. In patients with CKD 2b, a nephron-sparing strategy is indicated and should be prioritized when feasible.

Keywords

Carcinoma Renal cell Chronic kidney disease Glomerular filtration rate Nephrectomy Partial nephrectomy Overall survival 

Notes

Acknowledgements

This project was supported by the Stephen Weissman Kidney Cancer Research Fund. Biostatistical analyses were supported by NIH Grants UL1TR000100 and UL1TR001442.

Author contributions

ZAH: project development and manuscript writing/editing. UC: data interpretation and manuscript writing/editing. BRL: project development and manuscript writing/editing. AL: data collection, data analysis and manuscript writing/editing. KY: data collection, data analysis, and manuscript writing/editing. SD: data collection and data management and interpretation. BHC: data collection and manuscript writing/editing. MFM: data collection data management, and manuscript editing. SK: data collection, data management and interpretation. AB: data collection, and data management and interpretation. AE: data collection, data analysis and manuscript writing/editing. AB: data collection and data management. SR: data collection, data management, and manuscript writing. CC: data collection and manuscript editing. FW: data collection and data management. JP: data analysis and manuscript writing/editing. FM: project development and manuscript editing. IHD: protocol/project development and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest to declare.

Ethical standards

Ethical standards have been met; study is IRB approved at both institutions.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Zachary A. Hamilton
    • 1
  • Umberto Capitanio
    • 2
  • Brian R. Lane
    • 3
  • Alessandro Larcher
    • 2
  • Kendrick Yim
    • 1
  • Sumi Dey
    • 3
  • Brittney H. Cotta
    • 1
  • Margaret F. Meagher
    • 1
  • Samer Kirmiz
    • 3
  • Adam Bezinque
    • 3
  • Ahmed Eldefrawy
    • 1
  • Aaron Bradshaw
    • 1
  • Stephen Ryan
    • 1
  • Cristina Carenzi
    • 2
  • Fang Wan
    • 1
  • James Proudfoot
    • 1
  • Francesco Montorsi
    • 2
  • Ithaar H. Derweesh
    • 1
    • 4
    Email author
  1. 1.Department of UrologyUniversity of California San Diego School of MedicineLa JollaUSA
  2. 2.Department of Urology and Division of Experimental OncologyVita-Salute San Raffaele UniversityMilanItaly
  3. 3.Department of UrologySpectrum HealthGrand RapidsUSA
  4. 4.Department of UrologyMoores UCSD Cancer CenterLa JollaUSA

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