PD02-05 PARTIAL NEPHRECTOMY FOR PATIENTS WITH SEVERE CKD: IS IT WORTHWHILE?

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-05 PARTIAL NEPHRECTOMY FOR PATIENTS WITH SEVERE CKD: IS IT WORTHWHILE? Diego Aguilar Palacios*, Jianbo Li, Furman Mahmood, Robert Abouassaly, and Steven C. Campbell Diego Aguilar Palacios*Diego Aguilar Palacios* More articles by this author , Jianbo LiJianbo Li More articles by this author , Furman MahmoodFurman Mahmood More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , and Steven C. CampbellSteven C. Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is prioritized over radical nephrectomy (RN) in patients with CKD whenever feasible. However, we hypothesized that some patients with severe CKD might rapidly progress to end stage renal disease (ESRD), in which case the morbidity that can be associated with PN would not be justified. METHODS: Retrospective review of all 62 patient with stage IV CKD undergoing PN (1999-2015) was performed to evaluate preoperative/intraoperative factors and postoperative outcomes. ESRD was defined as postoperative initiation of permanent dialysis or eGFR<15ml/min/1.73m2. Survival analyses were used to evaluate factors associated with time to progression to ESRD. RESULTS: Median age was 67 years, 71% of patients were male and 84% were Caucasian. Comorbidities included hypertension (94%), cardiovascular disease (53%), diabetes (32%), and tobacco use (58%), and median preoperative eGFR was 23 ml/min/1.73m2. Open PN was performed in 45 patients (73%). Benign pathology was found in 10 patients (16%) and 7 had locally-advanced disease (11%). Unfavorable perioperative outcomes occurred in 15 patients (24%) defined as 90 day-mortality (3%), postoperative Clavien complication ≥IIIb (14%), or positive surgical margin (12%). Median time to progression to ESRD was only 27 months, and only 14 months in patients with preoperative GFR<20ml/min/1.73m2. In contrast, median time to progression to ESRD was 58 months in patients with preoperative GFR>25. On multivariable analysis African-American race [HR: 2.55 (1.10-5.95)], preoperative eGFR 20-25 or <20 [HR: 2.59 (1.16-5.84) and 5.03 (2.03-12.44), respectively] and minimally invasive approach [HR:2.05 (1.01-4.19)] were independently associated with progression to ESRD. CONCLUSIONS: Our data suggest that patients with stage IV CKD undergoing PN tend to have substantial comorbidities and are at risk for unfavorable perioperative outcomes and rapid progression to ESRD. Alternate strategies such as renal mass biopsy for oncologic risk stratification, active surveillance, or RN (either upfront or after progression to ESRD) may be more appropriate, particularly if PN is high complexity and African-American or when preoperative GFR<25. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e67-e68 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diego Aguilar Palacios* More articles by this author Jianbo Li More articles by this author Furman Mahmood More articles by this author Robert Abouassaly More articles by this author Steven C. Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...