PURPOSE: Chronic kidney disease(CKD) is associated with a higher likelihood of progression to end stage renal disease and increased mortality rates.
However, the etiology of nephron loss may modify the rate of CKD progression and overall survival.
MATERIAL/METHODS: Patients with suspected renal malignancy who had a new baseline GFR< 60 ml/min/1.73 m2 six weeks after surgery were divided into two groups: CKD-S (surgically induced CKD, preoperative GFR>60), and CKD-M/S (preexisting CKD due to medical causes followed by surgery). An independent cohort of subjects with CKD-M (entirely due to medical causes) served as a comparator.
RESULTS: Renal cancer surgery yielded cohorts with CKD-S (n=1097) and CKD-M/S (n=1053), whereas the CKD-M group consisted of 42,658 subjects. The CKD-M and CKD-M/S groups were older compared to CKD-S patients, had more medical comorbidities, and lower baseline GFR (all p < 0.001). The CKD-M/S group had lower new baseline GFR (37±10) compared to the CKD-S(48±9) and CKD-M(47±10) groups (p< 0.001). The probability of progressive decline in renal function (50% decline in GFR or need for dialysis) at 3 years was lowest for CKD-S, intermediate for CKD-M/S and highest for CKD-M, when age, gender, race, comorbidities, and new baseline GFR were taken into account (p< 0.001). Non-renal-cancer-related mortality was substantially lower for CKD-S when compared to the other groups(p< 0.001).
CONCLUSIONS: Our data suggest that CKD-S has a lower rate of functional decline and less impact on survival compared to medical causes of CKD. These data have potential implications with respect to classification of CKD and patient counseling for surgical management of various renal disorders, including renal cancer.
Written by:
Demirjian S, Lane BR, Derweesh IH, Takagi T, Fergany A, Campbell SC. Are you the author?
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland OH; Spectrum Health, Michigan State University School of Medicine; University of California, San Diego, School of Medicine.
Reference: J Urol. 2014 Apr 16. pii: S0022-5347(14)03344-8.
doi: 10.1016/j.juro.2014.04.016
PubMed Abstract
PMID: 24747655
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