Nephron-Sparing Treatments Underused in CKD Patients

Nephron-sparing modalities (NSM) are increasingly being used to treat small renal masses, but radical nephrectomy (RN) remains the more commonly used procedure, even among patients with chronic kidney disease, according to a new study.

The study, led by Ithaar H. Derweesh, MD, of the University of California-San Diego School of Medicine, examined 1998-2008 data from the Nationwide Inpatient Sample. The researchers identified 443,853 procedures performed during the study period: 338,687 RN, 79,568 partial nephrectomy (PN), and 25,599 cryo/radiofrequency ablation (C/RFA). The prevalence per 100,000 hospital admissions in 1998 was 87.1, 9.0, and 3.7 for RN, PN, and C/RFA, respectively, the researchers reported online ahead of print in BJU International. Over the study period, the prevalence increased by 2.2, 3.1, and 1.05 per 100,000 hospital admissions, respectively.

Of particular concern, the researchers noted, is that patients with pre-existing chronic kidney disease (CKD) had a nearly twofold increased likelihood of undergoing RN than NSM compared with patients without CKD. Even though NSM use increased over the study period, most CKD patients still received RN, the investigators found.

NSM was more likely to be used than RN in diabetics and patients receiving care at urban, teaching, and large capacity hospitals.

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