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Introduction: Partial nephrectomy (PN) has become the standard treatment for small renal masses, with studies suggesting comparable oncologic outcomes and increased preservation of renal function over radical nephrectomy (RN). The current study examined co-morbidities predisposing to chronic kidney disease and the utilization of PN over RN in treating renal masses.
Materials & Methods: The data for the present study came from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2012. International Classification of Diseases codes were used to identify patients undergoing partial nephrectomy or radical nephrectomy for a renal mass limited to the renal parenchyma. Patients with preexisting diabetes and hypertension were identified.
Results: We identified 66,187 patients who underwent nephrectomy for SRM. Of these, 4,691 (7%) were diabetics, 2,4917 (37.6%) were hypertensive, and 8,770 (13.4%) were diabetic and hypertensive. Patients with preexisting DM or HTN alone were more likely to undergo RN than PN when compared to patients without either comorbidity (OR=1.1694, 95% CI [1.093, 1.251], p<0.0001 and OR=1.042, 95% CI [1.004, 1.080], p=0.027, respectively). Patients suffering from both DM and HTN were equally likely to undergo PN or RN (OR=1.003, 95% CI [0.954, 1.0565], p<0.2531).
Conclusions: Contrary to the expected, patients with comorbidities contributing to chronic kidney disease were less likely to receive nephron sparing surgery. More investigation is required to explain these findings and the variables that lead providers to choose RN over PN for the treatment of SRMs in this select cohort of patients.