Kidney cancer patients have a lower risk of developing stage 4 or higher chronic kidney disease (CKD) following partial nephrectomy (PN) compared with radical nephrectomy (RN), a new study finds.

The relative impact of each surgery on kidney function has not been settled, so John T. Leppert, MD, of Stanford University School of Medicine in Stanford, California, and colleagues used the Veterans Health Administration 2001–2013 database to compare outcomes for 9759 radical RN and 4370 PN patients.

Stage 4 or higher CKD developed in 7.9% of those with preoperative estimated glomerular filtration rate (eGFR) at or above 30 mL/min/1.73 m2, according to results published online in the Journal of the American Society of Nephrology. Patients reached those stages at a median of 5 months after surgery. Subsequent progression was uncommon. Significant results showed that PN was associated with 66% lower risk.

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Patients with near-normal preoperative eGFR (at or above 60 mL/min/1.73 m2) fared similarly. PN was linked with a significant 85% lower risk for stage 3b or higher CKD. Again, the median time to significant kidney function decline was 5 months. Moreover, as other studies have shown, PN patients had a 45% lower risk of death.

“Together, these studies support the contemporary use of partial nephrectomy in older patients and those with impaired preoperative kidney function when feasible,” Dr Leppert and the team wrote. They recommended including patient age and preoperative kidney function in preoperative counseling. Each 0.1 mg/dL increase in preoperative serum creatinine, for example, was associated with increased risks of clinically significant CKD. The investigators also highlighted that surgically induced CKD may differ from kidney function decline compared with medical causes. 

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Leppert JT, Lamberts RW, Thomas IC, et al. Incident CKD after radical or partial nephrectomy. J Am Soc Nephrol. doi: 10.1681/ASN.2017020136