Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans

Elani Streja, Kamyar Kalantar-Zadeh, Miklos Z. Molnar, Jaime Landman, Onyebuchi A. Arah, Csaba P. Kovesdy

Research output: Contribution to journalArticle

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Abstract

Background. Partial nephrectomy is considered the preferred care for localized kidney tumors and may yield better patient and kidney survival and similar oncological outcomes compared with radical nephrectomy. We sought to reexamine these hypotheses in a large nationally representative cohort of US veterans who underwent radical or partial nephrectomy. Methods. We identified 7073 US veterans who had a partial or radical nephrectomy between 2004 and 2013.We collected data on estimated glomerular filtration rate (eGFR) prior to admission for nephrectomy surgery, immediately after surgery and 180 days postsurgery. We evaluated the association of nephrectomy type and eGFR at different time points with long-term mortality risk in adjusted survival models. Results. Patients who underwent radical (compared to partial) nephrectomy had a 2-fold greater decline in eGFR (21.8 6 17.7 versus 10.3 6 17.4 mL/min/1.73 m2) immediately after surgery. This larger drop in eGFR resulted in a larger proportion of radical nephrectomy patients having an eGFR <60 mL/min/1.73 m2 at 180 days postsurgery. Radical (compared to partial) nephrectomy patients also exhibited a 2.2-fold higher mortality [adjusted death hazard ratio 2.21 (95% confidence interval 1.91-2.55)]. Low eGFRs prior to surgery and 180 days postsurgery were associated with higher risk of postnephrectomy death. Conclusions. Worse postnephrectomy kidney function and higher mortality were observed with radical nephrectomy, and a low presurgical eGFR and a greater decrease in eGFR postsurgery were associated with worse mortality irrespective of the type of nephrectomy. Additional studies are needed to examine predictors of postnephrectomy outcomes.

Original languageEnglish (US)
Pages (from-to)95-101
Number of pages7
JournalNephrology Dialysis Transplantation
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2018

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Veterans
Nephrectomy
Chronic Renal Insufficiency
Disease Progression
Glomerular Filtration Rate
Mortality
Ambulatory Surgical Procedures
Kidney
Confidence Intervals
Survival

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

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Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans. / Streja, Elani; Kalantar-Zadeh, Kamyar; Molnar, Miklos Z.; Landman, Jaime; Arah, Onyebuchi A.; Kovesdy, Csaba P.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 1, 01.01.2018, p. 95-101.

Research output: Contribution to journalArticle

Streja, Elani ; Kalantar-Zadeh, Kamyar ; Molnar, Miklos Z. ; Landman, Jaime ; Arah, Onyebuchi A. ; Kovesdy, Csaba P. / Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 1. pp. 95-101.
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