Login to Access Video or Poster Abstract: MP72-15
Sources of Funding: none

Introduction

There is paucity of literature regarding short and long-term renal functional outcomes in patients with chronic kidney disease (CKD) undergoing robotic partial nephrectomy (RPN). We sought to objectively assess short and long term renal functional outcomes in patients with CKD undergoing RPN for suspicious renal masses.

Methods

We reviewed a prospectively maintained single surgeon database of patients who underwent RPN between 2010 - 2015. 182 patients who had pre- and post-operative (2 and 12 months post-op) MAG-3 renal scans comprised the study cohort. eGFR (in mL/min/1.73m2) preop and post-op (1 year) was calculated using the MDRD equation. CKD was defined as an eGFR <60 mL/min/1.73m2 (CKD category III & IV). Changes in creatinine, eGFR, and split renal function on renal scan were compared between patients with and without pre-operative CKD. Correlations between pre-op and post-op creatinine and eGFR were also calculated.

Results

Of 182 patients, 30 (16.5%) had CKD. Preop eGFR was 48.5 and 99.0 in the CKD and non-CKD groups, respectively (p <0.001; Table 2). Patients with CKD were more likely to have a malignant tumor on pathology (93.3% vs. 73.2%, p=0.02) and a higher Furhman Grade (3 or more: 49.7% vs 28.1 %, p<0.001). From pre-op to 12 months post-op, eGFR decreased by 2.8 and 1.1 mL/min/1.73m2 (p = 0.6) and the contribution of the surgical kidney on MAG3 renal scan decreased by 5.0 and 4.8% (p = 0.9) in the CKD and non-CKD cohorts, respectively (table 2). When comparing renal scans at 2 months 12 months of the cohort (figure1), the resected kidney recovered significantly (p<0.001) in both groups in a similar fashion (2.0% in CKD, 1.4% in no CKD p=0.6)_x000D_ Long-term follow up (median of 2.5 and 3.0 years for CKD and non-CKD groups, respectively) of eGFR change also did not show any difference compared to patients with normal kidney function (-2.8 vs -1.1 mL/min/1.73m2, p=0.6)._x000D_ _x000D_

Conclusions

RPN is a reasonable treatment option in patients with CKD as they did not experience a greater decline in renal function after RPN compared to patients without CKD. The long-term renal functional recovery parallels that of patients without CKD undergoing RPN. Of interest, CKD patients were more likely to have a malignant tumor with a higher Fuhrman grade; a factor to be considered when counseling patients regarding treatment options.

Funding

none