End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

Umberto Capitanio, Alessandro Larcher, Carlo Terrone, Alessandro Antonelli, Alessandro Volpe, Cristian Fiori, Maria Furlan, Federico Dehò, Andrea Minervini, Sergio Serni, Francesco Porpiglia, Francesco Trevisani, Andrea Salonia, Marco Carini, Claudio Simeone, Francesco Montorsi, Roberto Bertini

Research output: Contribution to journalArticlepeer-review

Abstract

Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate 2) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4-1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2-0.8; p =0.02) at multivariable analyses. Patient summary: After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy. After considering individual baseline characteristics such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.

Original languageEnglish
JournalEuropean Urology
DOIs
Publication statusAccepted/In press - 2016

Keywords

  • Dialysis
  • End-stage renal disease
  • Kidney cancer
  • Nephron-sparing surgery
  • Partial nephrectomy
  • Radical nephrectomy

ASJC Scopus subject areas

  • Urology

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