PD49-11 SURGICAL CHRONIC KIDNEY DISEASE APPEARS TO BE A DISTINCT SUBTYPE OF CHRONIC KIDNEY DISEASE BASED ON MORTALITY RISKS FOLLOWING RENAL SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy VI1 Apr 2015PD49-11 SURGICAL CHRONIC KIDNEY DISEASE APPEARS TO BE A DISTINCT SUBTYPE OF CHRONIC KIDNEY DISEASE BASED ON MORTALITY RISKS FOLLOWING RENAL SURGERY Ronak Gor, Robert Uzzo, Tianyu Li, Mohammed Haseebuddin, Nikhil Waingankar, Serge Ginzburg, Marc Smaldone, and Alexander Kutikov Ronak GorRonak Gor More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Tianyu LiTianyu Li More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2729AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic kidney disease (CKD) is associated with risk of all cause mortality. Removal of nephrons, via radical nephrectomy (RN), or nephron sparing surgery (NSS), results in immediate decline in renal function. Patients with preoperative GFR greater than 60 ml/min/1.73m2 may develop CKD after RN or NSS, termed, surgical CKD (CKD-S); however, recent work suggests preexisting CKD (CKD-M) may be a stronger predictor of overall survival (OS) than CKD-S. Thus, we set out to compare overall survival of patients with CKD-S and CKD-M to patients with normal perioperative renal function (No-CKD). METHODS Surgically treated patients between 1994 and 2014 with available pre and post-operative renal function data were identified in our prospectively maintained institutional registry. Kaplan-Meier (KM) survival curves with log rank statistic were used to assess OS based on pre and post-operative renal function. Multivariable analysis (MVA) was performed using Cox proportional hazard model to evaluate variables for independent association with OS. RESULTS Of 1454 patients who met inclusion criteria, 20.4% had CKD-M, 23.3% developed CKD-S, and 56.3% had No-CKD after surgery. Median follow-up was 3.5 years. Pre and post-operative renal function predicted OS on both univariate and multivariate analysis (MVA). KM curve separation was evident immediately following surgery. On MVA, after controlling for age, gender, race, hypertension, diabetes, coronary artery disease, peripheral vascular disease, congestive heart failure, and RN vs. NSS, CKD-S was not associated with a statistically significant difference in mortality compared with No-CKD (HR 1.2, 95% CI 0.9-1.6, p=0.21). Further, when compared to CKD-M, CKD-S and No-CKD groups had significantly lower risk of mortality (HR 0.76, 95% CI 0.57-1.00, p=0.05 and HR 0.63, 95% CI 0.47-0.86, p=0.003, respectively). CONCLUSIONS Renal function before and after kidney surgery predicts OS. Survival impact appears to be immediate, suggesting CKD status is a surrogate metric of mortality risk and likely not its primary cause. At intermediate follow-up, CKD-S has an attenuated correlation with OS compared to patients with CKD-M. As such, these findings support the concept of CKD-S as a distinct subtype of CKD. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byZabell J, Demirjian S, Lane B, Derweesh I, Isharwal S, Suk-Ouichai C, Wu J, Palacios D and Campbell S (2018) Predictors of Long-Term Survival after Renal Cancer SurgeryJournal of Urology, VOL. 199, NO. 2, (384-392), Online publication date: 1-Feb-2018. Volume 193Issue 4SApril 2015Page: e975-e976 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronak Gor More articles by this author Robert Uzzo More articles by this author Tianyu Li More articles by this author Mohammed Haseebuddin More articles by this author Nikhil Waingankar More articles by this author Serge Ginzburg More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...