title: End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline.
abstract: Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15ml/min per 1.73 m2) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4-1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2-0.8; p=0.02) at multivariable analyses.
  
  
  
  After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: umbertocapitanio@gmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Department of Urology, Universita' degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Department of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Department of Urology, Universita' degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Dehò
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; Unit of Nephrology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Trevisani
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Universita' degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
mesh_terms: D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D065840:Protective Factors; D012907:Smoking / Q000453:epidemiology
keywords: Dialysis; End-stage renal disease; Kidney cancer; Nephron-sparing surgery; Partial nephrectomy; Radical nephrectomy