title: New Chronic Kidney Disease and Overall Survival After Nephrectomy for Small Renal Cortical Tumors.
abstract: OBJECTIVE
  To evaluate kidney functional and overall survival (OS) outcomes in a cohort of patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) for tumors ≤4 cm.
  
  
  METHODS
  We performed a retrospective study on 2110 patients who underwent PN or RN with normal contralateral kidneys and normal serum creatinine from 1989 through 2012. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Primary end points were baseline incidence of CKD, OS, and new onset of eGFR ≤60 and ≤45 mL/min/1.73 m(2).
  
  
  RESULTS
  Preoperatively, 30% and 8% of the cohort had eGFR ≤60 and ≤45 mL/min/1.73 m(2), respectively. Five-year freedom from eGFR ≤60 mL/min/1.73 m(2) was 24% (95% confidence interval [CI], 19%-30%) and 76% (95% CI, 72%-78%) for RN and PN, respectively, and 5-year freedom from eGFR ≤45 mL/min/1.73 m(2) was 51% (95% CI, 45%-56%) and 91% (95% CI, 89%-93%) for RN and PN, respectively. On multivariable analysis, hazard ratio for RN vs PN was 4.98 (95% CI, 4.11-6.04, P <.0001) for new onset of eGFR ≤60 mL/min/1.73 m(2) and 9.28 (95% CI, 7.26-11.86, P <.0001) for new onset of eGFR ≤45 mL/min/1.73 m(2). The RN group had a higher rate of death per year than the partial group (hazard ratio = 1.61, 95% CI, 1.24-2.08, P = .0003).
  
  
  CONCLUSIONS
  The present study confirms published works demonstrating that a significant proportion of patients have pre-existing CKD. In patients with normal kidney function, RN is associated with a significantly higher risk for developing CKD and worse OS than PN.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Mashni
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Melissa
authors.initials: M
authors.lastname: Assel
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Maschino
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mary
authors.initials: M
authors.lastname: Russo
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Brendan
authors.initials: B
authors.lastname: Masi
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: russop@mskcc.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D057234:Preoperative Period; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000503:physiopathology*; D012189:Retrospective Studies; D015996:Survival Rate