Leppert JT, et al. - This study assessed the risk of clinically significant (stage 4 and higher) CKD among veterans who underwent partial or radical nephrectomy for kidney cancer in the Veterans Health Administration (2001–2013). Findings demonstrated an association of partial nephrectomy with a marked reduction in the incidence of clinically significant CKD and with enhanced survival, compared with radical nephrectomy. In addition, the kidney function decline noted primarily in the first postoperative period appeared to stabilize over time.

Methods

• Researchers assessed the risk of clinically significant (stage 4 and higher) CKD following radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001–2013).

Results

• Data reported that the overall incidence of CKD stage 4 or higher after radical (n=9759) or partial nephrectomy (n=4370) was 7.9% among patients with preoperative eGFR≥30 ml/min per 1.73 m².
• The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed.
• Findings demonstrated that partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher in propensity score–matched cohorts (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy).
• Furthermore, the association of partial nephrectomy with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score–matched cohorts was indicated in a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m²).
• In addition, it was shown that competing risk regression models produced consistent results.
• Finally, reduced risk of mortality was observed in patients treated with a partial nephrectomy (hazard ratio, 0.55; 95% CI, 0.49 to 0.62).