You have accessJournal of UrologyKidney Cancer: Surgical Therapy I1 Apr 2015PD29-09 EXTENDED FOLLOW-UP OF CHRONIC KIDNEY DISEASE DUE TO SURGICAL REMOVAL OF NEPHRONS: IMPACT ON SURVIVAL AND FUNCTIONAL STABILITY Sevag Demirjian, Brian Lane, Ithar Derweesh, Toshio Takagi, Zhiling Zhang, Liliya Velet, Cesar Ercole, Amr Fergany, and Steven Campbell Sevag DemirjianSevag Demirjian More articles by this author , Brian LaneBrian Lane More articles by this author , Ithar DerweeshIthar Derweesh More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Zhiling ZhangZhiling Zhang More articles by this author , Liliya VeletLiliya Velet More articles by this author , Cesar ErcoleCesar Ercole More articles by this author , Amr FerganyAmr Fergany More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic kidney disease (CKD) can be associated with increased risk of progression to end-stage renal disease and higher mortality rates. However, etiology of nephron loss may modify these risks. Previous studies noted CKD due to surgical removal of nephrons (CKD-S) may be more stable and associated with better survival than CKD due to medical causes (CKD-M); however, some limitations prevented definitive conclusions. Here we address key limitations with longer follow-up, differentiation of cause of death, and control for potential confounding factors. METHODS From 1999-2008, 4299 patients underwent surgery for renal cancer at a single institution were divided into 3 groups: no CKD (n=1949) for whom new baseline GFR (ml/min/1.73m2) after surgery remained >60; CKD-S (n=1113) for whom new baseline GFR was <60 after surgery but preoperative GFR was above this level; and CKD-M/S (n=1237) for whom new baseline GFR and preoperative GFR were both <60. New baseline GFR was defined as the highest GFR within 42 days postop. We evaluated for stability of renal function, overall survival, and non-RCC related survival. Median follow-up was 9.4 years. RESULTS The CKD-M/S group had higher incidence of DM, HTN, and cardiac disease, and new baseline GFR was lower (38 for CKD-M/S, 49 for CKD-S, and 79 for no CKD). On multivariable analysis (controlling for age, gender, race, DM, HTN, and cardiac disease) the CKD-M/S group demonstrated higher relative rates of progressive decline of renal function (50% decline or need for dialysis), all-cause mortality, and non-RCC related mortality when referenced to the CKD-S and no CKD groups (all HR=1.69-2.33, all p<0.05). In contrast the relative rates of these outcomes were similar for the CKD-S group when referenced to the no CKD group (HR=1.10, 1.19, and 1.07, respectively). New baseline GFR also proved to be a significant predictor of renal functional decline and mortality, particularly if <40-45. CONCLUSIONS CKD-S is more stable than CKD-M/S and exhibits better survival that approximates that of patients with no CKD. However, if new baseline GFR is <40-45 the risk of renal functional decline and mortality appears to rise. These findings, which are more robust with almost 10 years of median follow-up and more stringent control of confounding factors, may influence counseling for patients with localized renal cancer with increased oncologic potential and a normal contralateral kidney. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e652 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sevag Demirjian More articles by this author Brian Lane More articles by this author Ithar Derweesh More articles by this author Toshio Takagi More articles by this author Zhiling Zhang More articles by this author Liliya Velet More articles by this author Cesar Ercole More articles by this author Amr Fergany More articles by this author Steven Campbell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...