In urology we are encountering an ageing and more comorbid population, including a group of patients with chronic kidney disease (CKD). In this retrospective study, a group from the Cleveland Clinic present the extended follow-up of patients with and without chronic kidney disease (CKD) undergoing renal cancer surgery, and the outcomes of those with new CKD following intervention compared with pre-existing CKD. In total, the records of 4299 patients undergoing renal cancer surgery from 1999-2008 were reviewed. Preoperative and new baseline glomerular filtration rate (GFR), which was the optimal GFR reached postoperatively until day 42, were evaluated. Patients were divided into three categories: those with no CKD (pre and postoperative GFR>60ml/min/1.73m²), those with surgically induced CKD (CKD-S, postoperative GFR alone <60ml/min/1.73m²) and pre-existing medical CKD with postoperative CKD (CKD-M/S, both values <60ml/min/1.73m²). Outcomes reviewed included a decline in renal function (50% reduction in GFR or need for dialysis), all-cause and non-renal cancer cause mortality. Fifty-five percent of patients had postoperative CKD (1237 CKD-M/S and 1113 CKD-S). Those with pre-existing CKD tended to be older and more comorbid as would be expected. However, on multivariate analysis, controlling for variables including race, age, gender and comorbidities, the study identified a more rapid decline in renal function in the CKD-M/S cohort compared to both the CKD-S and no CKD cohorts, as well as higher all-cause and non-renal cancer cause mortality rates. A new baseline GFR>45ml/min/1.73m² was associated with a more favourable outcome than values below this. The rate of CKD progression between the CKD-S and no CKD group was minimal, with no significant difference in the non-renal cancer cause mortality. Although this is a retrospective study, and further prospective evaluation would help to confirm the findings, the results of this study may help us to counsel patients with and without preoperative CKD undergoing renal cancer surgery.
Outcomes of renal cancer surgery on renal function and mortality on those with and without CKD
Reviewed by Sophia Cashman
Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate.
