Post-Nephrectomy ESRD Among Patients With Severe CKD 

The American Urological Association recommends nephron sparing in patients with preexisting CKD, but few studies have examined long-term kidney function in patients with preoperative severe CKD who have extirpative renal surgery. 

Abhinav Khanna, MD, MPH, and colleagues compared the hazard of progression to ESRD after partial nephrectomy (PN) and radical nephrectomy (RN) among patients with preoperative severe CKD. Their study included 186 patients with stage 4 CKD who underwent PN or RN between 1970 and 2018. They utilized a multivariable Fine-Gray subdistribution hazard model to assess associations with progression to ESRD while accounting for competing risk of death. 

Seventy-one (38%) patients underwent PN, while 115 (62%) had RN for renal neoplasms. Median follow-up was 6.9 years (IQR, 3.8-14.1). Multivariable analyses adjusting for competing risk of death found that the subdistribution HR (SHR) for older age at surgery (SHR for five-year increase, 0.81; 95% CI, 0.73-0.91; P<.001) and a higher preoperative eGFR (SHR for five-unit increase, 0.63; 95% CI, 0.47-0.84; P=.002) was associated with a lower hazard of progression to ESRD. PN and RN demonstrated no significant difference in the hazard of ESRD (SHR, 0.82; 95% CI, 0.50-1.33; P=.4). 

In summary, a higher preoperative eGFR was associated with a lower hazard of progression to ESRD after nephrectomy for renal neoplasms. There was no significant difference between PN and RN surgeries regarding the overall hazard for developing ESRD. 

Source: Journal of Urology. 2024 Oct;212(4):550-559