title: Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end-stage renal disease (ESRD).
abstract: OBJECTIVE
  To assess whether radical nephrectomy (RN) compared with partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) is associated with greater risk of end-stage renal disease (ESRD).
  
  
  METHODS
  We performed a population-based, retrospective cohort study using linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed RCC diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment choice. The primary outcome was ESRD. Secondary outcomes included overall mortality, myocardial infarction, and new-onset chronic kidney disease (CKD). A modern cohort of patients (2003-2010) was analysed separately.
  
  
  RESULTS
  We included 11,937 patients, of whom 2107 (18%) underwent PN. The median follow-up was 57 months. In the full cohort, type of surgery was not associated with the rate of ESRD, whereas PN was associated with a decreased likelihood of ESRD compared with RN in the modern cohort using a multivariable proportional hazards model [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.25-0.75) or propensity score modelling (HR 0.48, 95% CI 0.27-0.82). PN was also associated with a lower risk of new-onset CKD (HR 0.48, 95% CI 0.41-0.57).
  
  
  CONCLUSIONS
  Although it is well-known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with less ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC.
authors: Department of Urology, University of California Davis, Sacramento, CA, USA.
authors: Stanley A
authors: SA
authors: Yap
authors: Division of Urologic Oncology, Princess Margaret Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: Antonio
authors: A
authors: Finelli
authors: Institute of Health Policy, Management, University of Toronto, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors: David R
authors: DR
authors: Urbach
authors: Institute of Health Policy, Management, University of Toronto, Toronto, ON, Canada.
authors: George A
authors: GA
authors: Tomlinson
authors: Institute of Health Policy, Management, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Shabbir M H
authors: SM
authors: Alibhai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D009864:Ontario; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: kidney failure; kidney neoplasms; nephrectomy; renal insufficiency