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Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery
Author(s) -
Wu Jitao,
SukOuichai Chalairat,
Dong Wen,
Antonio Elvis Caraballo,
Derweesh Ithaar H.,
Lane Brian R.,
Demirjian Sevag,
Li Jianbo,
Campbell Steven C.
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13994
Subject(s) - medicine , renal function , interquartile range , kidney disease , urology , nephrectomy , cohort , proportional hazards model , kidney cancer , surgery , kidney
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 to 2008, 4 246 patients underwent RCS at our centre. The median (interquartile range [ IQR ]) follow‐up was 9.4 (7.3–11.0) years. New baseline glomerular filtration rate ( GFR ) was defined as highest GFR between nadir and 6 weeks after RCS . We retrospectively evaluated three cohorts: no‐ CKD (new baseline GFR of ≥60 mL/min/1.73 m 2 ); CKD ‐S (new baseline GFR of <60 mL/min/1.73 m 2 but preoperative GFR of ≥60 mL/min/1.73 m 2 ); and CKD due to medical aetiologies who then require RCS ( CKD ‐M/S, preoperative and new baseline GFR both <60 mL/min/1.73 m 2 ). Analysis focused primarily on non‐renal cancer‐related survival ( NRCRS ) for the CKD ‐S cohort. Kaplan–Meier analysis assessed the longitudinal impact of new baseline GFR (45–60 mL/min/1.73 m 2 vs <45 mL/min/1.73 m 2 ) and Cox regression evaluated relative impact of preoperative GFR , new baseline GFR , and relevant demographics/comorbidities. Results Of the 4 246 patients who underwent RCS , 931 had CKD ‐S and 1 113 had CKD ‐M/S, whilst 2 202 had no‐ CKD even after RCS . Partial/radical nephrectomy ( PN / RN ) was performed in 54%/46% of the patients, respectively. For CKD ‐S, 641 patients had a new baseline GFR of 45–60 mL/min/1.73 m 2 and 290 had a new baseline GFR of <45 mL/min/1.73 m 2 . Kaplan–Meier analysis showed significantly reduced NRCRS for patients with CKD ‐S with a GFR of <45 mL/min/1.73 m 2 compared to those with no‐ CKD or CKD ‐S with a GFR of 45–60 mL/min/1.73 m 2 (both P ≤ 0.004), and competing risk analysis confirmed this ( P < 0.001). Age, gender, heart disease, and new baseline GFR were 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 a reduced new baseline GFR have compromised survival, particularly if <45 mL/min/1.73 m 2 . Our findings may have implications regarding choice of PN / RN in patients at risk of developing CKD ‐S.