To compare renal functional changes after percutaneous cryoablation (CA) or partial nephrectomy (PN).
Patients who underwent CA or PN for a solitary renal mass at a single institution were identified (2003-2013). Estimated glomerular filtration rates (eGFR) were calculated at baseline, discharge, and 3 months follow-up using the Chronic Kidney Disease Epidemiology Collaboration equation. Changes in renal function were compared between groups using 1:1 propensity score (PS) matching, adjustment for PS quintile, and inverse probability weighting (IPW).
There were 2,040 procedures available for the PS analyses, including 448 CA and 1,592 PN. After PS adjustments, there were no significant differences in baseline clinical features between CA and PN patients. In the PS matched analysis, the changes in eGFR from baseline to discharge for CA and PN patients were -3.1 and -1.1 ml/min/1.73m(2) (p=0.038) with percent changes of -4.5% and 0% (p=0.006). From baseline to 3-month follow-up, the absolute changes in eGFR for CA and PN patients were -4.3 and -2.1 ml/min/1.73m(2) (p=0.008) and the percent changes were -6.1% and -2.4% (p=0.005). Similar results were obtained after adjusting for PS quintiles and in the IPW analysis. Importantly, the rate of CKD stage progression at 3-months follow-up was similar between groups (21% versus 18%).
Our results confirm that both CA and PN have a minor impact on renal function. While we observed a statistically greater decline in eGFR after CA compared with PN, both approaches result in excellent preservation of renal function. This article is protected by copyright. All rights reserved.
BJU international. 2017 May 26 [Epub ahead of print]
Ross J Mason, Thomas D Atwell, Christine Lohse, Bimal Bhindi, Adam Weisbrod, Stephen A Boorjian, Bradley C Leibovich, Grant D Schmit, R Houston Thompson
Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Radiology, Mayo Clinic, Rochester, MN, USA., Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.