End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline
Abstract Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the p...
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| Veröffentlicht in: | European urology 2016-10, Vol.70 (4), p.558-561 |
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| creator | Capitanio, Umberto Larcher, Alessandro Terrone, Carlo Antonelli, Alessandro Volpe, Alessandro Fiori, Cristian Furlan, Maria Dehò, Federico Minervini, Andrea Serni, Sergio Porpiglia, Francesco Trevisani, Francesco Salonia, Andrea Carini, Marco Simeone, Claudio Montorsi, Francesco Bertini, Roberto |
| description | Abstract Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate |
| doi_str_mv | 10.1016/j.eururo.2016.03.023 |
| format | Article |
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In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15 ml/min per 1.73 m2 ) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4–1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2–0.8; p = 0.02) at multivariable analyses. Patient summary After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2016.03.023</identifier><identifier>PMID: 27021797</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Aged ; Comorbidity ; Diabetes Mellitus - epidemiology ; Dialysis ; End-stage renal disease ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Hypertension - epidemiology ; Kidney - physiology ; Kidney cancer ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - prevention & control ; Kidney Neoplasms - physiopathology ; Kidney Neoplasms - surgery ; Male ; Middle Aged ; Nephrectomy - methods ; Nephron-sparing surgery ; Organ Sparing Treatments - statistics & numerical data ; Partial nephrectomy ; Proportional Hazards Models ; Protective Factors ; Radical nephrectomy ; Smoking - epidemiology ; Urology</subject><ispartof>European urology, 2016-10, Vol.70 (4), p.558-561</ispartof><rights>European Association of Urology</rights><rights>2016 European Association of Urology</rights><rights>Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-6efcf951845f9fd86d6a33b6081e088bec9a0522f28592eda39147567da76bdf3</citedby><cites>FETCH-LOGICAL-c463t-6efcf951845f9fd86d6a33b6081e088bec9a0522f28592eda39147567da76bdf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283816003730$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27021797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Capitanio, Umberto</creatorcontrib><creatorcontrib>Larcher, Alessandro</creatorcontrib><creatorcontrib>Terrone, Carlo</creatorcontrib><creatorcontrib>Antonelli, Alessandro</creatorcontrib><creatorcontrib>Volpe, Alessandro</creatorcontrib><creatorcontrib>Fiori, Cristian</creatorcontrib><creatorcontrib>Furlan, Maria</creatorcontrib><creatorcontrib>Dehò, Federico</creatorcontrib><creatorcontrib>Minervini, Andrea</creatorcontrib><creatorcontrib>Serni, Sergio</creatorcontrib><creatorcontrib>Porpiglia, Francesco</creatorcontrib><creatorcontrib>Trevisani, Francesco</creatorcontrib><creatorcontrib>Salonia, Andrea</creatorcontrib><creatorcontrib>Carini, Marco</creatorcontrib><creatorcontrib>Simeone, Claudio</creatorcontrib><creatorcontrib>Montorsi, Francesco</creatorcontrib><creatorcontrib>Bertini, Roberto</creatorcontrib><title>End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Abstract Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15 ml/min per 1.73 m2 ) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4–1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2–0.8; p = 0.02) at multivariable analyses. 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Larcher, Alessandro ; Terrone, Carlo ; Antonelli, Alessandro ; Volpe, Alessandro ; Fiori, Cristian ; Furlan, Maria ; Dehò, Federico ; Minervini, Andrea ; Serni, Sergio ; Porpiglia, Francesco ; Trevisani, Francesco ; Salonia, Andrea ; Carini, Marco ; Simeone, Claudio ; Montorsi, Francesco ; Bertini, Roberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-6efcf951845f9fd86d6a33b6081e088bec9a0522f28592eda39147567da76bdf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Comorbidity</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Dialysis</topic><topic>End-stage renal disease</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Hypertension - epidemiology</topic><topic>Kidney - physiology</topic><topic>Kidney cancer</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Kidney Failure, Chronic - prevention & control</topic><topic>Kidney Neoplasms - physiopathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephrectomy - methods</topic><topic>Nephron-sparing surgery</topic><topic>Organ Sparing Treatments - statistics & numerical data</topic><topic>Partial nephrectomy</topic><topic>Proportional Hazards Models</topic><topic>Protective Factors</topic><topic>Radical nephrectomy</topic><topic>Smoking - epidemiology</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Capitanio, Umberto</creatorcontrib><creatorcontrib>Larcher, Alessandro</creatorcontrib><creatorcontrib>Terrone, Carlo</creatorcontrib><creatorcontrib>Antonelli, Alessandro</creatorcontrib><creatorcontrib>Volpe, Alessandro</creatorcontrib><creatorcontrib>Fiori, Cristian</creatorcontrib><creatorcontrib>Furlan, Maria</creatorcontrib><creatorcontrib>Dehò, Federico</creatorcontrib><creatorcontrib>Minervini, Andrea</creatorcontrib><creatorcontrib>Serni, Sergio</creatorcontrib><creatorcontrib>Porpiglia, Francesco</creatorcontrib><creatorcontrib>Trevisani, Francesco</creatorcontrib><creatorcontrib>Salonia, Andrea</creatorcontrib><creatorcontrib>Carini, Marco</creatorcontrib><creatorcontrib>Simeone, Claudio</creatorcontrib><creatorcontrib>Montorsi, Francesco</creatorcontrib><creatorcontrib>Bertini, Roberto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Capitanio, Umberto</au><au>Larcher, Alessandro</au><au>Terrone, Carlo</au><au>Antonelli, Alessandro</au><au>Volpe, Alessandro</au><au>Fiori, Cristian</au><au>Furlan, Maria</au><au>Dehò, Federico</au><au>Minervini, Andrea</au><au>Serni, Sergio</au><au>Porpiglia, Francesco</au><au>Trevisani, Francesco</au><au>Salonia, Andrea</au><au>Carini, Marco</au><au>Simeone, Claudio</au><au>Montorsi, Francesco</au><au>Bertini, Roberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>70</volume><issue>4</issue><spage>558</spage><epage>561</epage><pages>558-561</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>Abstract Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15 ml/min per 1.73 m2 ) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4–1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2–0.8; p = 0.02) at multivariable analyses. Patient summary After accounting for individual baseline characteristics, such as age, diabetes, uncontrolled hypertension, or other comorbidities, partial nephrectomy independently protects against end-stage renal disease and the consequent need for dialysis relative to radical nephrectomy.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>27021797</pmid><doi>10.1016/j.eururo.2016.03.023</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Comorbidity Diabetes Mellitus - epidemiology Dialysis End-stage renal disease Female Follow-Up Studies Glomerular Filtration Rate Humans Hypertension - epidemiology Kidney - physiology Kidney cancer Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - prevention & control Kidney Neoplasms - physiopathology Kidney Neoplasms - surgery Male Middle Aged Nephrectomy - methods Nephron-sparing surgery Organ Sparing Treatments - statistics & numerical data Partial nephrectomy Proportional Hazards Models Protective Factors Radical nephrectomy Smoking - epidemiology Urology |
| title | End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline |
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