This study aimed to evaluate the likelihood of progression to chronic kidney disease (CKD) in a cohort of geriatric Asian patients aged over 65 years who underwent either partial nephrectomy (PN) or radical nephrectomy (RN) for localised pT1 kidney tumours.
Geriatric patients aged over 65 years who underwent PN or RN for localised kidney mass < 7 cm at a single institution from 2005 to 2014 were reviewed retrospectively. Preoperative and postoperative estimated glomerular filtration rates (eGFRs) were calculated using the Modification of Diet in Renal Disease Study equation. Clinicopathological data was analysed for new-onset CKD after at least five years of follow-up. Postoperative complications were measured by the modified Clavien classification system.
Among 67 patients, 36.4% had diabetes mellitus and 80.3% had hypertension. Pre-existing CKD with eGFR ≤ 60 mL/min/1.73 m2 was present in 23.3% of PN and 43.2% of RN patients. RN and PN patients had similar postoperative morbidity. Those who underwent PN had immediate decline followed by gradual improvement of their kidney functions at six months after surgery and this improvement was sustained even for patients with four years of clinical follow-up. Among patients with normal preoperative kidney functions, new-onset CKD after surgery was found in 20.0% and 52.9% of PN and RN patients, respectively (p = 0.007).
In our study, geriatric patients who underwent PN for localised kidney mass < 7 cm had immediate decline but gradual and sustained improvement in kidney functions. PN also resulted in fewer new-onset CKD through a five-year follow-up period.
Singapore medical journal. 2019 Nov 04 [Epub ahead of print]
Jing Kai Jackie Lam, Sher Yin Tan, Kian Tai Chong
Ministry of Health Holdings, Singapore., Urology, PanAsia Surgery, Singapore.