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

Overview

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.