Robot-assisted Partial Nephrectomy in Patients with Baseline Chronic Kidney Disease: A Multi-institutional Propensity Score-Matched Analysis

作者：Kumar Ramesh K; Sammon Jesse D; Kaczmarek Bartosz F; Khalifeh Ali; Gorin Michael A; Sivarajan Ganesh; Tanagho Youssef S; Bhayani Sam B; Stifelman Michael D; Allaf Mohamad E; Kaouk Jihad H; Rogers Craig G^*

来源：European Urology, 2014, 65(6): 1205-1210.

DOI：10.1016/j.eururo.2013.12.004

• Nephron-sparing surgery
• Chronic kidney disease
• Robotic partial nephrectomy

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.

• 出版日期2014-6