title: Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans.
abstract: Partial nephrectomy is considered the preferred care for localized kidney tumors and may yield better patient and kidney survival and similar oncological outcomes compared with radical nephrectomy. We sought to reexamine these hypotheses in a large nationally representative cohort of US veterans who underwent radical or partial nephrectomy.
  
  
  
  We identified 7073 US veterans who had a partial or radical nephrectomy between 2004 and 2013. We collected data on estimated glomerular filtration rate (eGFR) prior to admission for nephrectomy surgery, immediately after surgery and 180 days postsurgery. We evaluated the association of nephrectomy type and eGFR at different time points with long-term mortality risk in adjusted survival models.
  
  
  
  Patients who underwent radical (compared to partial) nephrectomy had a 2-fold greater decline in eGFR (-21.8 ± 17.7 versus -10.3 ± 17.4 mL/min/1.73 m2) immediately after surgery. This larger drop in eGFR resulted in a larger proportion of radical nephrectomy patients having an eGFR <60 mL/min/1.73 m2 at ≥180 days postsurgery. Radical (compared to partial) nephrectomy patients also exhibited a 2.2-fold higher mortality [adjusted death hazard ratio 2.21 (95% confidence interval 1.91-2.55)]. Low eGFRs prior to surgery and 180 days postsurgery were associated with higher risk of postnephrectomy death.
  
  
  
  Worse postnephrectomy kidney function and higher mortality were observed with radical nephrectomy, and a low presurgical eGFR and a greater decrease in eGFR postsurgery were associated with worse mortality irrespective of the type of nephrectomy. Additional studies are needed to examine predictors of postnephrectomy outcomes.
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
authors: Elani
authors: E
authors: Streja
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.|Department of Medicine, UC Irvine School of Medicine, Irvine, CA, USA.
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Department of Urology, UC Irvine School of Medicine, Irvine, CA, USA.
authors: Jaime
authors: J
authors: Landman
authors: Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA.
authors: Onyebuchi A
authors: OA
authors: Arah
authors: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.|Nephrology Section, Memphis Veterans Affairs Medical Center, 1030 Jefferson Ave., Memphis, TN 38104, USA.
authors: Csaba P
authors: CP
authors: Kovesdy
mesh_terms: D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: chronic kidney disease; eGFR; partial and radical nephrectomy; renal cell carcinoma; survival analysis