Preoperative Chronic Kidney Disease Status is an Independent Prognostic Factor in Patients with Renal Cell Carcinoma.

PURPOSE: Preoperative chronic kidney disease (CKD) status may affect disease outcomes in patients with renal cell carcinoma (RCC). This study evaluated the influence of preoperative CKD status on clinicopathological features and prognosis in patients with RCC.

METHODS: Between 1999 and 2011, a total of 1855 patients underwent radical nephrectomy at various centers throughout Korea. Of these patients, 1655 had an estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m(2) (non-CKD group) and 200 patients had an eGFR ≥30 but <60 ml/min/1.73 m(2) (CKD group). To reduce the effects of selection bias and potential confounding factors, 600 patients in the non-CKD group were selected by propensity-score matching.

RESULTS: The median age of all patients was 57.3 years (range 20-94 years) and the median follow-up was 35.0 months (range 1-154 months). Comparisons of the propensity-score-matched cohorts showed that T and N stages were more advanced and tumor size was larger in the CKD group than in the non-CKD group (p < 0.05 each). Kaplan-Meier analyses showed that recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS) were significantly lower in the CKD group (p < 0.01 each). Multivariate regression analysis showed that preoperative CKD status was an independent predictor of CSS and OS in patients with RCC (p < 0.05 each).

CONCLUSIONS: Preoperative CKD may be associated with more aggressive features and poorer prognosis in patients with RCC. RCC patients with preoperative CKD should be carefully and frequently followed-up after nephrectomy.