title: Robot-assisted partial nephrectomy in patients with baseline chronic kidney disease: a multi-institutional propensity score-matched analysis.
abstract: 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.
  
  
  METHODS
  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 15-60 ml/min per 1.73 m(2)) were identified. Perioperative results of 121 patients were compared against propensity score-matched controls without CKD (eGFR ≥60 ml/min per 1.73 m(2)).
  
  
  METHODS
  RPN in patients with or without baseline CKD.
  
  
  METHODS
  Descriptive statistics and propensity score-matched operative and functional outcomes.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Kumar
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Bartosz F
authors.initials: BF
authors.lastname: Kaczmarek
authors.affiliation: The Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sivarajan
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Youssef S
authors.initials: YS
authors.lastname: Tanagho
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.affiliation: The Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA. Electronic address: crogers2@hfhs.org.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D059351:Organ Sparing Treatments; D011184:Postoperative Period; D057234:Preoperative Period; D057216:Propensity Score; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures
keywords: Chronic kidney disease; Nephron-sparing surgery; Robotic partial nephrectomy