To evaluate effects of worsening surgically induced chronic kidney disease (CKD-S) on oncologic and non-oncologic survival outcomes in renal cell carcinoma (RCC).
We performed a retrospective analysis of patients who underwent Partial (PN) or Radical Nephrectomy (RN) and were free of preoperative CKD (eGFR≥60 mL/min/1. 73m2). Patients were stratified by CKD stage at last follow-up: no CKD-S (eGFR≥60), de novo CKD-S 3a (eGFR 45-59), CKD-S 3b (eGFR<45 and ≥30) and CKD-S 4 (eGFR<30 and ≥15). Primary outcome was all-cause mortality (ACM). Secondary outcomes included non-cancer mortality (NCM), cancer specific mortality (CSM), and de novo CKD-S Stage 3/4. Multivariable analysis (MVA) was utilized to identify risk factors for outcomes. Kaplan-Meier analysis (KMA) was utilized to evaluate overall (OS), non-cancer (NCS), and cancer-specific (CSS) survival with respect to CKD-S categories.
We analyzed 3239 patients. Mean preoperative/last-follow up eGFR were 87.4 and 69.5, respectively. On last follow-up, 57.9% (n=1876) had no CKD-S, 18.7% (n=606) had CKD-S 3a, 15.1% (n=489) had CKD-S 3b and 8.3% (n=268) had CKD-S 4. On MVA, de novo CKD-S 3b/4 were independently associated with ACM (HR 1.3-2.1, p=0.003-0.001) and NCM (HR 1.5-2.8, p=0.021-0.001), but not CSM (p=0.219-0.909); de novo CKD-S 3a was not predictive for any mortality outcomes (p=0.102-0.81). RN was independently associated with CKD-S 3-4 (HR 1.78-1.99, p<0.001-0.035). Comparing no CKD-S, CKD-S 3a, CKD-S 3b and CKD-S 4, KMA demonstrated worsening outcomes with progressive CKD-S stage: 5-year OS 84% vs. 78% vs. 71% vs. 60%, p<0.001 and 5-year NCS 93% vs. 87% vs. 83% vs. 72%, p<0.001.
Development of CKD-S Stage 3b and 4, but not 3a, was associated with worsened ACM and NCM. Decision to proceed with nephron preservation via PN should be individualized based on oncological risk and risk of functional decline to CKD-S 3b or 4, and not CKD-S 3a.
BJU international. 2022 Jul 25 [Epub ahead of print]
Mimi V Nguyen, Arman Walia, Ava Saidian, Dhruv Puri, Margaret F Meagher, Kevin Hakimi, Hajime Tanaka, Dattatraya Patil, Yosuke Yasuda, Kazutaka Saito, Sohail Dehanji, Clara Cerrato, Rekha Narasimhan, John Perry, Viraj Master, Yasuhisa Fujii, Ithaar H Derweesh
Department of Urology, La Jolla, CA; UC San Diego School of Medicine, La Jolla, USA; 2Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan; 3Department of Urology, Emory University School of Medicine, Atlanta, USA.