Steven C. Campbell, Ithaar H. Derweesh, Elvis Caraballo Antonio, Wen Dong, Sevag Demirjian, Jitao Wu, Chalairat Suk-Ouichai, Jianbo Li, Brian R. Lane
Objectives
To evaluate predictors of long-term survival for patients with chronic kidney disease primarily due to surgery (CKD-S). Patients with CKD-S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort.
Patients and Methods
From 1997-2008, 4,246 patients underwent RCS at our center. Median follow-up was 9.4 years (IQR=7.3-11.0). New baseline GFR was defined as highest GFR between nadir and 6 weeks after surgery. We retrospectively evaluated 3 cohorts: no-CKD (new baseline GFR≥60ml/min/1.73m2); CKD-S (new baseline GFR<60ml/min/1.73m2 but preoperative GFR≥60ml/min/1.73m2); and CKD-M/S (preoperative and new baseline GFR both <60ml/min/1.73m2). Analysis focused primarily on non-renal cancer-related survival (NRCRS) for the CKD-S cohort. Kaplan-Meier assessed longitudinal impact of new baseline GFR (45-60ml/min/1.73m2 versus <45ml/min/1.73m2) and Cox regression evaluated relative impact of preoperative GFR, new baseline GFR, and relevant demographics/comorbidities.
Results
Of 4,246 patients who underwent RCS, 931 had CKD-S and 1,113 had CKD-M/S, while 2,202 had no-CKD even after surgery. Partial/radical nephrectomy (PN/RN) were performed in 54%/46% of patients, respectively. For CKD-S, 641 patients had new baseline GFR 45-60ml/min/1.73m2 and 290 had new baseline GFR<45ml/min/1.73m2. Kaplan-Meier demonstrated significantly reduced NRCRS for CKD-S with GFR<45ml/min/1.73m2 compared to no-CKD or CKD-S with GFR 45-60ml/min/1.73m2 (both p≤0.004), and competing risk analysis confirmed this (p<0.001). Age/gender/heart disease, and new baseline GFR all associated independently with NRCRS for patients with CKD-S (all p≤0.02).
Conclusion
Our data suggest that CKD-S is heterogeneous, and patients with reduced new baseline GFR have compromised survival, particularly if <45ml/min/1.73m2. Our findings may have implications regarding choice of PN/RN in patients at risk for developing CKD-S.
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