We investigated the risks of new onset and worsened hypertension after radical vs partial nephrectomy.
Using a national administrative database of privately and Medicare insured patients we performed a retrospective cohort study of 9,207 and 4,686 patients who underwent radical and partial nephrectomy, respectively, for a renal mass between January 1, 2007 and December 31, 2016. One to one propensity score matching was done to balance the surgical groups based on patient demographics, baseline comorbidities, current medications and surgery year. Primary outcomes included new onset hypertension among patients with no history of hypertension and worsened hypertension among patients with baseline hypertension. We performed subgroup analyses stratified by patient age (75 or greater vs less than 75 years) and the presence of baseline kidney disease. Incidence rates and Cox proportional hazards models were used to compare outcomes in matched cohorts.
Among 3,106 propensity matched patients without preexisting hypertension radical nephrectomy was associated with a higher risk of new onset hypertension compared to partial nephrectomy (HR 1.40, 95% CI 1.22-1.60, p <0.001). Similarly among 6,250 propensity matched patients with hypertension prior to surgery radical nephrectomy was associated with a higher risk of worsening baseline hypertension (HR 1.18, 95% CI 1.10-1.26, p <0.001). Subgroup analyses were consistent with the main study findings of worsened hypertension (p for interaction ≥0.05).
Radical nephrectomy was associated with a higher risk of new onset and worsened hypertension compared to partial nephrectomy, including among elderly patients and individuals with normal kidney function. Given prior noted associations between hypertension and noncancer related morbidity, our results further encourage the preferential use of partial nephrectomy to manage localized renal masses when technically feasible.
The Journal of urology. 2019 Feb 12 [Epub ahead of print]
Paras H Shah, Bradley C Leibovich, Holly Van Houten, Timothy D Lyon, Xiaoxi Yao, Meghan Knoedler, Lindsey Sangaralingham, Andrea Kattah, R Houston Thompson, Nilay D Shah, Stephen A Boorjian
Departments of Urology, Mayo Clinic , Rochester , Minnesota., Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester , Minnesota., Nephrology and Hypertension, Mayo Clinic , Rochester , Minnesota.