MP42-14 UPSTAGING OF CHRONIC KIDNEY DISEASE AFTER PARTIAL AND RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-14 UPSTAGING OF CHRONIC KIDNEY DISEASE AFTER PARTIAL AND RADICAL NEPHRECTOMY Cameron Britton, Christine Lohse, Abhinav Khanna, Vidit Sharma, John Cheville, Stephen Boorjian, Bradley Leibovich, H. Robert Thompson, and Aaron Potretzke Cameron BrittonCameron Britton More articles by this author , Christine LohseChristine Lohse More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Vidit SharmaVidit Sharma More articles by this author , John ChevilleJohn Cheville More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , H. Robert ThompsonH. Robert Thompson More articles by this author , and Aaron PotretzkeAaron Potretzke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is generally preferred over radical nephrectomy (RN) when technically feasible. Nephron-sparing surgery may be particularly important for patients with chronic kidney disease (CKD). There is sparse literature comparing the outcomes of PN and RN in patients with CKD. We aim to illustrate the degree of renal functional change between PN and RN based on baseline renal function. METHODS: Adults treated with PN or RN for unilateral, sporadic, solid renal masses between 1980 and 2018 were identified. Patients who underwent PN or RN for a solitary kidney, were on dialysis at the time of surgery, or had stage 5 CKD at the time of surgery were excluded. Outcomes included positive margins, 30-day complications, and postoperative renal function assessed by CKD upstaging and percent change in eGFR at 3 months and 1 year following surgery compared to preoperative eGFR. Comparisons of outcomes were evaluated using chi-square, Fisher exact, and Wilcoxon rank sum tests. RESULTS: Amongst a total of 6,912 patients, 2,751 (40%) underwent PN and 4,161 (60%) underwent RN; 70 (2.5%) PNs and 99 (2.4%) RNs resulted in positive surgical margins (p=0.7); 164 (6%) PNs and 209 (5%) RNs resulted in Clavien grade 3 or higher complications. There were 3,471 and 3,256 patients with a 3-month and 1-year postoperative eGFR available for analysis. The interactions between type of surgery and CKD stage in models to predict CKD upstaging and percent change in eGFR were statistically significant (p <0.001 for all), indicating that the association of type of surgery with these outcomes differed by baseline CKD stage; as such, associations of type of surgery with 3-month and 1-year CKD upstaging and percent change in eGFR were stratified by CKD stage (Table). CONCLUSIONS: Patients with preoperative CKD stages 1-3 who underwent PN had significantly less renal functional decline at 3-months and 1-year as assessed by CKD upstaging and percent change in eGFR when compared to patients who underwent RN. There was no significant difference in renal functional outcomes in patients with baseline CKD stage 4, possibly reflecting a selection bias. Patients with stage 3 CKD, in particular, should be counseled regarding the reduced risk of CKD progression with PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e777-e777 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cameron Britton More articles by this author Christine Lohse More articles by this author Abhinav Khanna More articles by this author Vidit Sharma More articles by this author John Cheville More articles by this author Stephen Boorjian More articles by this author Bradley Leibovich More articles by this author H. Robert Thompson More articles by this author Aaron Potretzke More articles by this author Expand All Advertisement PDF DownloadLoading ...