title: Comparison of progression to end-stage renal disease requiring dialysis after partial or radical nephrectomy for renal cell carcinoma in patients with severe chronic kidney disease.
abstract: OBJECTIVE
  We analyzed trends related to surgical approach for renal cell carcinoma (RCC), including partial nephrectomy (PN) or radical nephrectomy (RN), in patients with stage 4 chronic kidney disease (CKD), and identified predictors for postoperative progression to end-stage renal disease (ESRD) requiring permanent dialysis.
  
  
  METHODS
  We enrolled patients with stage 4 CKD who underwent surgery for non-metastatic RCC. We compared their characteristics according to surgical approach (PN vs. RN). Moreover, predictors for postoperative progression to requiring permanent dialysis were determined using multivariable analyses. The Charlson comorbidity index (CCI) was adjusted for age.
  
  
  RESULTS
  Fifty-one patients (PN 23, RN 28) were evaluated in the present study. Their mean preoperative estimated glomerular filtration rate (eGFR) was 24 ml/min/1.73 m(2), and four patients had a solitary kidney. Three of 23 patients (13 %) who underwent PN progressed to requiring dialysis after surgery after a median 16 months. In contrast, 13 of 28 patients (46 %) who underwent RN developed dialysis immediately after surgery (median 2 days). Patients who underwent PN had lower T stages (T1, PN 100 % vs. RN 50 %, p = 0.004) and smaller tumors (31 mm vs. 65 mm, p < 0.0001) than did those who underwent RN. RN and lower preoperative eGFR significantly predicted progression to requiring dialysis, while tumor size and CCI did not.
  
  
  CONCLUSIONS
  PN tended to be selected for patients with lower T stage and smaller tumors in the limited cohort of stage 4 CKD patients. PN had a significant benefit of preventing dialysis in the multivariable analysis.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. t.takagi1192@gmail.com.
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Omae
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Junpei
authors.initials: J
authors.lastname: Iizuka
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011184:Postoperative Period; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D047368:Tumor Burden
keywords: Chronic kidney disease; Kidney neoplasm; Nephrectomy