The following is a summary of “Advanced chronic kidney disease; A comparison between nephroureterectomy and nephron-sparing surgery for upper tract urothelial carcinoma,” published in the June 2023 issue of the Urologic Oncology by Dudinec et al.
In patients with upper tract urothelial carcinoma (UTUC), the renal function outcomes between radical nephroureterectomy (RNU) and nephron-sparing surgery (NSS) are not well established. Researchers aimed to compare the incidence and risk factors for advanced chronic kidney disease (CKD) between RNU and NSS and acute kidney injury (AKI) ‘s influence on renal function outcomes. They performed a retrospective database analysis on patients who underwent RNU or NSS for UTUC.
The cumulative incidence of advanced postoperative CKD, defined as eGFR <30 ml/min/1.73 m2, was compared between groups. Using Fine-Gray competing risk regression, predictors of advanced CKD were identified. Locally weighted scatterplot smoothing was employed to determine postoperative eGFR trends. AKI events were counted, staged, and their impact on progression to advanced CKD was evaluated. There were 426 patients included in the analysis, with a median follow-up of 6.68 years (IQR: 3.4–12.2). Both groups had comparable preoperative eGFR (NSS: 68 ml/min/1.73 m2; RNU: 65 ml/min/1.73 m2; P = 0.220). In the NSS cohort, the cumulative incidence of advanced CKD was substantially lower (P = 0.009).
Age, diabetes, recurrent AKI, and RNU were factors associated with CKD progression. The proportion of patients with an AKI event varied between groups (51.5% NSS, 72.7% RNU, P =<0.001), but there was no difference in the proportion of patients with recurrent AKI (25.6% NSS, 25.6% RNU, P = 1). NSS has a beneficial effect on renal function in UTUC. AKI is prevalent in patients with UTUC, and recurrent AKI is a risk factor for developing advanced CKD.
Source: sciencedirect.com/science/article/abs/pii/S1078143922004835
