Patients with chronic kidney disease (CKD) are more likely to experience postoperative complications following radical prostatectomy (RP) for prostate cancer than those without CKD, according to a new study.
In a population-based retrospective investigation using data from the US National Inpatient Sample, Chen Ning, MD, of Capital Medical University Beijing Friendship Hospital in Beijing, China, and colleagues studied 136,790 men who underwent RP for prostate cancer from 2005 to 2014. The group included 134,751 men without CKD, 1766 with CKD, and 273 with end-stage renal disease (ESRD). In adjusted analyses, patients with CKD had a significant 36% increased risk of postoperative complications and 5-fold increased risk of postoperative acute kidney injury (AKI) and urinary complications compared with patients without CKD, the investigators reported in BMC Nephrology. ESRD was not significantly associated with postoperative complications. The investigators did not include the ESRD group in their analysis of postoperative AKI and urinary complications. Both the CKD and ESRD groups had significantly longer hospital stays than the non-CKD group.
“Patients receiving radical prostatectomy should be carefully evaluated for kidney dysfunction, as this factor significantly affects post-surgical outcomes,” Dr Ning’s team concluded.
The investigators also examined the effect of surgical approach on clinical outcomes. For the overall study population, patients undergoing robotic-assisted RP (RARP) had significant 45% decreased odds of postoperative complications than those undergoing open RP (ORP). In the non-CKD, CKD, and ESRD groups, RARP was associated with significant 46%, 35%, and 57% decreased odds of postoperative complications, respectively.
In a discussion of study limitations, the authors noted that they identified patients with CKD or ESRD using ICD-9-CM codes. The ICD-9 diagnosis for CKD is highly specific, but its sensitivity is only about 80%. “Therefore, some patients with milder degrees of CKD may have been misclassified as not having CKD,” they pointed out.
Ning C, Hu X, Liu F, et al. Post-surgical outcomes of patients with chronic kidney disease and end stage renal disease undergoing radical prostatectomy: 10-year results from the US National Inpatient Sample. BMC Nephrol. 2019;20:278. doi: 10.1186/s12882-019-1455-2