The authors retrospectively evaluated 6319 patients with renal tumors from 1980 to
2018 of whom 56% were treated with radical nephrectomy (RN) and 44% with partial nephrectomy
(PN). They utilized multivariable linear and competing risk Cox proportional hazards
models for increase in chronic kidney disease (CKD) staging to determine if there
was a significant interaction between type of operation and preoperative CKD stage.
They reported 12 months eGFR calculations in 3046 (48%) of the patients. Of note,
2055 patients (33%) had significant preexisting CKD (eGFR<60), 3466 patients (54%)
had hypertension, 843 patients (13%) were diabetic, and 3440 patients (54%) were former
or current smokers. In this study, of the 3564 patients undergoing RN, 2469 (70%)
had tumors that were T2 or greater (median size 6.8 cm) compared to 133 of 2755 patients
(5%, median size 3.0 cm) who underwent PN. Interestingly, 851 patients (13%) had benign
disease on final pathology. The authors reported that percent change in eGFR at 1
year was significantly worse for RN compared to PN and RN was significantly more likely
to result in CKD stage progression compared with PN for CKD stages 1-3b but not stage
4 (eGFR 14-29).
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