End-Stage Kidney Disease After Partial and Radical Nephrectomy Among Patients with Severe Chronic Kidney Disease

No AccessJournal of UrologyAdult Urology27 Jun 2024End-Stage Kidney Disease After Partial and Radical Nephrectomy Among Patients with Severe Chronic Kidney Disease Abhinav Khanna, Harrison C. Gottlich, Maddy Dorr, Christine M. Lohse, Andrew Zganjar, Vidit Sharma, Daniel Joyce, Aaron Potretzke, Cameron Britton, Andrew D. Rule, Stephen A. Boorjian, Bradley C. Leibovich, and R. Houston Thompson Abhinav KhannaAbhinav Khanna Department of Urology, Mayo Clinic, Rochester, Minnesota , Harrison C. GottlichHarrison C. Gottlich https://orcid.org/0000-0001-7357-5540 Alix School of Medicine, Mayo Clinic, Rochester, Minnesota , Maddy DorrMaddy Dorr Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota , Christine M. LohseChristine M. Lohse Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota , Andrew ZganjarAndrew Zganjar Department of Urology, Mayo Clinic, Rochester, Minnesota , Vidit SharmaVidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota , Daniel JoyceDaniel Joyce Department of Urology, Mayo Clinic, Rochester, Minnesota , Aaron PotretzkeAaron Potretzke Department of Urology, Mayo Clinic, Rochester, Minnesota , Cameron BrittonCameron Britton Department of Urology, Mayo Clinic, Rochester, Minnesota , Andrew D. RuleAndrew D. Rule Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota , Bradley C. LeibovichBradley C. Leibovich Department of Urology, Mayo Clinic, Rochester, Minnesota , and R. Houston ThompsonR. Houston Thompson Corresponding Author: R. Houston Thompson, MD, Professor of Urology, Mayo Clinic, First St SW, Rochester, MN 55905 ( ([email protected]) ). View All Author Informationhttps://doi.org/10.1097/JU.0000000000004124AboutPDF Cite Export CitationSelect Citation formatNLMIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: AUA guidelines prioritize nephron-sparing in patients with pre-existing chronic kidney disease (CKD). However, few studies analyze long-term renal function in patients with pre-operative severe CKD who undergo extirpative renal surgery. Herein, we compare the hazard of progression to end-stage kidney disease (ESKD) following partial nephrectomy (PN) and radical nephrectomy (RN) among patients with pre-operative severe CKD. Methods: Patients with stage 4 CKD who underwent PN or RN from 1970 to 2018 were identified. A multivariable Fine-Gray subdistribution hazard model was employed to assess associations with progression to ESKD accounting for the competing risk of death. Results: A total of 186 patients with stage 4 CKD underwent PN (n = 71; 38%) or RN (n = 115; 62%) for renal neoplasms with median follow-up of 6.9 years (IQR 3.8-14.1). On multivariable analyses adjusting for competing risk of death, the subdistribution hazard ratio (SHR) for older age at surgery (SHR for 5-year increase 0.81; 95% CI 0.73-0.91; P < .001) and higher pre-operative eGFR (SHR for 5-unit increase 0.63; 95% CI 0.47-0.84; P = .002) were associated with lower hazard of progression to ESKD. There was no significant difference in hazard of ESKD between PN and RN (SHR 0.82; 95% CI 0.50-1.33; P = .4). Conclusions: Among patients with pre-operative severe CKD, higher pre-operative eGFR was associated with lower hazard of progression to ESKD after extirpative surgery for renal neoplasms. We did not observe a significant difference in overall hazard for developing ESKD between PN and RN. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Abhinav Khanna Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Harrison C. Gottlich Alix School of Medicine, Mayo Clinic, Rochester, Minnesota More articles by this author Maddy Dorr Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota More articles by this author Christine M. Lohse Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota More articles by this author Andrew Zganjar Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Vidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Daniel Joyce Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Aaron Potretzke Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Cameron Britton Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Andrew D. Rule Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Bradley C. Leibovich Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author R. Houston Thompson Corresponding Author: R. Houston Thompson, MD, Professor of Urology, Mayo Clinic, First St SW, Rochester, MN 55905 ( ([email protected]) ). More articles by this author Expand All Advertisement PDF downloadLoading ...