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Surgical Chronic Kidney Disease Imparts Attenuated Mortality Risks and Renal Functional Decline than Medical Chronic Kidney Disease
Ronak Gor1, Robert Uzzo2, Tianyu Li3, Mohammed Haseebudin3, Nikhil Waingankar3, Serge Ginzburg1, Marc Smaldone3, Alexander Kutikov3 1Einstein Healthcare Network, Philadelphia, PA;2Fox Chase Cancer Center and Einstein Healthcare Network, Philadelphia, PA;3Fox Chase Cancer Center, Philadelphia, PA
Introduction Chronic kidney disease (CKD) is associated with risk of all-cause mortality. Radical nephrectomy (RN), or nephron sparing surgery (NSS), results in immediate renal functional decline. Patients may develop CKD after RN or NSS, termed, surgical CKD (CKD-S); however, recent work suggests preexisting CKD (CKD-M) may be a stronger predictor of overall survival (OS) than CKD-S. Methods Surgically treated patients from 1994-2014 with available pre/post-operative renal function data were identified in our prospectively maintained institutional registry. Kaplan-Meier (KM) survival curves with log rank statistic were used to assess OS based on pre/post-operative renal function. Multivariable analysis (MVA) was performed using Cox proportional hazard model to evaluate variables for independent association with OS. Results On MVA, CKD-S was not associated with a statistically significant difference in mortality compared with No-CKD (HR 1.2, 95% CI 0.9-1.6, p=0.21). Further, when compared to CKD-M, CKD-S and No-CKD groups had significantly lower risk of mortality (HR 0.76, 95% CI 0.57-1.00, p=0.05 and HR 0.63, 95% CI 0.47-0.86, p=0.003, respectively). Renal functional decline was significantly higher in patients with CKD-M than in patients with CKD-S (P=0.0013). Conclusion Renal function before and after kidney surgery predicts OS. Survival impact appears to be immediate, suggesting CKD status is a surrogate metric of mortality risk and likely not its primary cause. CKD-S has an attenuated correlation with OS compared to patients with CKD-M. Renal functional decline in CKD-S has slower kinetics compared with CKD-M. As such, these findings support the concept of CKD-S as a distinct subtype of CKD.
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