Partial Nephrectomy Does Not Eliminate CKD Risk

The risk is particularly elevated for patients who have CKD risk factors, such as hypertension, diabetes, and older age.
The risk is particularly elevated for patients who have CKD risk factors, such as hypertension, diabetes, and older age.

Patients who have medical risk factors for chronic kidney disease (CKD) are at increased risk of progressive renal impairment despite the use of partial nephrectomy (PN), according to new study findings published online in BJU International.

The study, by Prassannah Satasivam, MD, of Monash Health in Melbourne, and colleagues, included 488 patients undergoing surgery for renal cell carcinoma (RCC). Of these, 156 underwent PN and 332 underwent radical nephrectomy (RN). RN was associated with a 2.7 times increased risk of a new-onset CKD (estimated glomerular filtration rate [eGFR] below 60 mL/min/1.73 m2) compared with PN. Patients undergoing PN, however, were still at risk of new-onset CKD. 

The proportion of PN patients who experienced new-onset CKD more than 6 months after surgery was 7% for those without CKD risk factors, including hypertension, diabetes mellitus, cardiovascular disease, obesity, high cholesterol, family history of CKD, and age, the researchers reported. This proportion rose to 24%, 30%, and 42% for patients older than 60 years and those with hypertension or diabetes mellitus, respectively.

“We contend that, where appropriate, PN should be considered in those patients with normal preoperative renal function and who possess risk factors for future impairment,” the authors concluded.

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