BACKGROUND: Robot-assisted partial nephrectomy (RPN) in the setting of chronic kidney disease (CKD) presents additional challenges for the preservation of renal function.
OBJECTIVE: To evaluate functional outcomes of RPN in patients with CKD relative to patients undergoing RPN without baseline CKD.
DESIGN, SETTING, AND PARTICIPANTS: A total of 1197 consecutive patients who underwent RPN at five academic institutions between 2007 and 2012 were identified for this descriptive study. A total of 172 patients who underwent RPN with preexisting CKD (estimated glomerular filtration rate [eGFR] of 15-60ml/min per 1.73 m2) were identified. Perioperative results of 121 patients were compared against propensity score-matched controls without CKD (eGFR ≥60ml/min per 1.73 m2).
INTERVENTION: RPN in patients with or without baseline CKD.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics and propensity score-matched operative and functional outcomes.
RESULTS AND LIMITATIONS: After propensity score matching, patients with baseline CKD had a lower percentage eGFR decrease at first follow-up (-5.1 vs -10.9), which remained significant at a mean follow-up of 12.6 mo (-2.8 vs -9.1, p< 0.05), and they had less CKD upstaging (11.8% vs 33.1%). CKD patients were less likely to be discharged in the first two postoperative days (39.7% vs 56.2%, p=0.006) and had a higher rate of surgical complications (21.5% vs 10.7%, p=0.007). The retrospective analysis was the main limitation of this study.
CONCLUSIONS: RPN in patients with baseline CKD is associated with a smaller decrease in renal function compared with patients without baseline CKD, but a higher risk of surgical complications and a longer hospital stay.
Written by:
Kumar RK, Sammon JD, Kaczmarek BF, Khalifeh A, Gorin MA, Sivarajan G, Tanagho YS, Bhayani SB, Stifelman MD, Allaf ME, Kaouk JH, Rogers CG. Are you the author?
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; The Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology, New York University, Langone Medical Center, New York, NY, USA; Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Reference: Eur Urol. 2013 Dec 14. pii: S0302-2838(13)01325-0.
doi: 10.1016/j.eururo.2013.12.004
PubMed Abstract
PMID: 24388436
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