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  • Title: Robot-assisted partial nephrectomy in patients with baseline chronic kidney disease: a multi-institutional propensity score-matched analysis.
    Author: Kumar RK, Sammon JD, Kaczmarek BF, Khalifeh A, Gorin MA, Sivarajan G, Tanagho YS, Bhayani SB, Stifelman MD, Allaf ME, Kaouk JH, Rogers CG.
    Journal: Eur Urol; 2014 Jun; 65(6):1205-10. PubMed ID: 24388436.
    Abstract:
    BACKGROUND: Robot-assisted partial nephrectomy (RPN) in the setting of chronic kidney disease (CKD) presents additional challenges for the preservation of renal function. OBJECTIVE: To evaluate functional outcomes of RPN in patients with CKD relative to patients undergoing RPN without baseline CKD. DESIGN, SETTING, AND PARTICIPANTS: A total of 1197 consecutive patients who underwent RPN at five academic institutions between 2007 and 2012 were identified for this descriptive study. A total of 172 patients who underwent RPN with preexisting CKD (estimated glomerular filtration rate [eGFR] of 15-60 ml/min per 1.73 m(2)) were identified. Perioperative results of 121 patients were compared against propensity score-matched controls without CKD (eGFR ≥60 ml/min per 1.73 m(2)). INTERVENTION: RPN in patients with or without baseline CKD. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics and propensity score-matched operative and functional outcomes. RESULTS AND LIMITATIONS: After propensity score matching, patients with baseline CKD had a lower percentage eGFR decrease at first follow-up (-5.1 vs -10.9), which remained significant at a mean follow-up of 12.6 mo (-2.8 vs -9.1, p<0.05), and they had less CKD upstaging (11.8% vs 33.1%). CKD patients were less likely to be discharged in the first two postoperative days (39.7% vs 56.2%, p=0.006) and had a higher rate of surgical complications (21.5% vs 10.7%, p=0.007). The retrospective analysis was the main limitation of this study. CONCLUSIONS: RPN in patients with baseline CKD is associated with a smaller decrease in renal function compared with patients without baseline CKD, but a higher risk of surgical complications and a longer hospital stay.
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