The effect of chronic kidney disease on adverse in-hospital outcomes after partial nephrectomy

Introduction: Preoperative chronic kidney disease (CKD) frequently affects patients with renal cell carcinoma undergoing partial nephrectomy (PN). However, the association between CKD and adverse in-hospital outcomes after PN has not been thoroughly investigated. Methods: Descriptive analyses, 1:2 propensity score matching (PSM) and multivariable logistic and Poisson regression models were used within the National Inpatient Sample (2006–2019) PN patients. CKD severity was stratified as mild (stage II) vs. moderate (stage III) vs. severe (stage IV/V). Results: Of 33,639 PN patients, 3,473 (10.4%) had CKD, classified as mild (1,821, 5.4%), moderate (1,343, 4.0%), and severe (309, 0.9%). In PN patients, overall CKD rate increased from 4.3–14.1% (2006–2019, EAPC: + 7.2%, p < 0.001). Any CKD in PN patients was associated with higher rates of adverse in-hospital outcomes in 14 of 15 categories, including acute kidney injury (+ 26.2%), overall complications (+ 22.6%), and prolonged length of stay (+ 13.5%, all p < 0.001). After detailed multivariable adjustment, any CKD in PN independently predicted higher rates of adverse in-hospital outcomes in 14 of 15 examined categories, with the odds ratio (OR) ranging from 8.13 for dialysis for acute kidney failure, 6.70 for acute kidney injury, and 2.6 for overall complications (all p < 0.001). Similar observations were made in analyses that relied on specific CKD severity (mild, moderate and severe). Conclusion: CKD patients invariably exhibited higher rates of adverse in-hospital outcomes after PN. In consequence, they should be given special attention for preoperative optimization, especially when CKD is either moderate or severe.