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摘要
ObjectivesTo evaluate predictors of long-term survival for patients with chronic kidney disease primarily due to surgery (CKD-S). Patients with CKD-S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort. Patients and MethodsFrom 1997 to 2008, 4246 patients underwent RCS at our centre. The median (interquartile range [IQR]) follow-up was 9.4 (7.3-11.0) years. New baseline glomerular filtration rate (GFR) was defined as highest GFR between nadir and 6weeks after RCS. We retrospectively evaluated three cohorts: no-CKD (new baseline GFR of 60mL/min/1.73m(2)); CKD-S (new baseline GFR of <60mL/min/1.73m(2) but preoperative GFR of 60mL/min/1.73m(2)); and CKD due to medical aetiologies who then require RCS (CKD-M/S, preoperative and new baseline GFR both <60mL/min/1.73m(2)). Analysis focused primarily on non-renal cancer-related survival (NRCRS) for the CKD-S cohort. Kaplan-Meier analysis assessed the longitudinal impact of new baseline GFR (45-60mL/min/1.73m(2) vs <45mL/min/1.73m(2)) and Cox regression evaluated relative impact of preoperative GFR, new baseline GFR, and relevant demographics/comorbidities. ResultsOf the 4246 patients who underwent RCS, 931 had CKD-S and 1113 had CKD-M/S, whilst 2202 had no-CKD even after RCS. Partial/radical nephrectomy (PN/RN) was performed in 54%/46% of the patients, respectively. For CKD-S, 641 patients had a new baseline GFR of 45-60mL/min/1.73m(2) and 290 had a new baseline GFR of <45mL/min/1.73m(2). Kaplan-Meier analysis showed significantly reduced NRCRS for patients with CKD-S with a GFR of <45mL/min/1.73m(2) compared to those with no-CKD or CKD-S with a GFR of 45-60mL/min/1.73m(2) (both P0.004), and competing risk analysis confirmed this (P<0.001). Age, gender, heart disease, and new baseline GFR were all associated independently with NRCRS for patients with CKD-S (all P0.02). ConclusionOur data suggest that CKD-S is heterogeneous, and patients with a reduced new baseline GFR have compromised survival, particularly if <45mL/min/1.73m(2). Our findings may have implications regarding choice of PN/RN in patients at risk of developing CKD-S.
