Robot-assisted Partial Nephrectomy in Patients with Baseline Chronic Kidney Disease: A Multi-institutional Propensity Score–Matched Analysis

Abstract

BackgroundRobot-assisted partial nephrectomy (RPN) in the setting of chronic kidney disease (CKD) presents additional challenges for the preservation of renal function. ObjectiveTo evaluate functional outcomes of RPN in patients with CKD relative to patients undergoing RPN without baseline CKD. Design, setting, and participantsA total of 1197 consecutive patients who underwent RPN at five academic institutions between 2007 and 2012 were identified for this descriptive study. A total of 172 patients who underwent RPN with preexisting CKD (estimated glomerular filtration rate [eGFR] of 15–60ml/min per 1.73 m2) were identified. Perioperative results of 121 patients were compared against propensity score–matched controls without CKD (eGFR ≥60ml/min per 1.73 m2). InterventionRPN in patients with or without baseline CKD. Outcome measurements and statistical analysisDescriptive statistics and propensity score–matched operative and functional outcomes. Results and limitationsAfter propensity score matching, patients with baseline CKD had a lower percentage eGFR decrease at first follow-up (−5.1 vs −10.9), which remained significant at a mean follow-up of 12.6 mo (−2.8 vs −9.1, p<0.05), and they had less CKD upstaging (11.8% vs 33.1%). CKD patients were less likely to be discharged in the first two postoperative days (39.7% vs 56.2%, p=0.006) and had a higher rate of surgical complications (21.5% vs 10.7%, p=0.007). The retrospective analysis was the main limitation of this study. ConclusionsRPN in patients with baseline CKD is associated with a smaller decrease in renal function compared with patients without baseline CKD, but a higher risk of surgical complications and a longer hospital stay.