TY - JOUR
T1 - End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function
T2 - Balancing Surgical Strategy and Individual Disorders at Baseline
AU - Capitanio, Umberto
AU - Larcher, Alessandro
AU - Terrone, Carlo
AU - Antonelli, Alessandro
AU - Volpe, Alessandro
AU - Fiori, Cristian
AU - Furlan, Maria
AU - Dehò, Federico
AU - Minervini, Andrea
AU - Serni, Sergio
AU - Porpiglia, Francesco
AU - Trevisani, Francesco
AU - Salonia, Andrea
AU - Carini, Marco
AU - Simeone, Claudio
AU - Montorsi, Francesco
AU - Bertini, Roberto
N1 - Publisher Copyright:
© 2016 European Association of Urology
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15 ml/min per 1.73 m2) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4–1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2–0.8; p = 0.02) at multivariable analyses. Patient summary After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.
AB - Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15 ml/min per 1.73 m2) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4–1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2–0.8; p = 0.02) at multivariable analyses. Patient summary After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.
KW - Dialysis
KW - End-stage renal disease
KW - Kidney cancer
KW - Nephron-sparing surgery
KW - Partial nephrectomy
KW - Radical nephrectomy
UR - http://www.scopus.com/inward/record.url?scp=84961827506&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2016.03.023
DO - 10.1016/j.eururo.2016.03.023
M3 - Article
SN - 0302-2838
VL - 70
SP - 558
EP - 561
JO - European Urology
JF - European Urology
IS - 4
ER -