Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end-stage renal disease (ESRD)

Stanley Yap, Antonio Finelli, David R. Urbach, George A. Tomlinson, Shabbir M H Alibhai

Research output: Contribution to journalArticle

20 Scopus citations

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). Patients and 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.

Original languageEnglish (US)
Pages (from-to)897-906
Number of pages10
JournalBJU International
Volume115
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • kidney failure
  • kidney neoplasms
  • nephrectomy
  • renal insufficiency

ASJC Scopus subject areas

  • Urology

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