Surveillance of cT1 Renal Masses is Common in Patients with CKD

Document Type

Conference Proceeding

Publication Date

9-1-2023

Publication Title

J Endourol

Abstract

Introduction: Patients with chronic kidney disease (CKD) and T1 renal masses (T1RM) represent a difficult group to treat. Most published data support the important role of partial nephrectomy (PN) in this context, however real-world decision making is complex and most published series use intervention as the trigger for inclusion. This selection bias has likely led to under-reporting of surveillance. We aim to describe GFR outcomes and treatment trends in patients with CKD and T1RM within practices participating in MUSIC- KIDNEY. Methods: We reviewed the MUSIC-KIDNEY registry for patients undergoing urologic evaluation for T1RM from 9/2017 to 1/2022. Patients were categorized as having CKD if pre-existing GFR was < 60 ml/min/1.73m2, or without CKD when GFR ≥60. Inclusion criteria mandated that GFR data was available at ≥6 months post-diagnosis. The primary outcome was “substantial GFR decline,” defined as a drop of > 15% and to GFR< 45. Trends in treatment and GFR outcomes were compared between patients with or without CKD and between treatment categories. Results: We identified 3,036 patients evaluated for T1RM. 839 (28%) had pre-existing CKD. Similar rates of ablation and RN were seen between the CKD and no-CKD groups. Interestingly, rather than an increase in rate of PN in the CKD group, a decline was seen (17% in CKD vs. 34% in no-CKD). A concomitant increase in rate of surveillance was observed (61% in CKD vs. 47% in no-CKD) (Figure 1a). Among CKD patients, active surveillance was more likely to be used in older patients (76 yr vs. 67 yr) with greater comorbidity (48 with CCI ≥2 vs. 47% with CCI = 0) and smaller masses (2.3 cm vs. 3.2 cm) when compared to PN. Of the 822 patients with 6 month follow up, 102 (12%) had a substantial decline in GFR: 27% of those with pre-existing CKD and 7% without CKD. PN and RN led to notably higher rates of GFR decline in those with pre-existing CKD compared to those without (Figure 1b). Conclusions: Despite the long-held notion that patients with T1RM and CKD have an imperative indication for nephronsparing interventions, predominately PN, our study suggests urologists and patients commonly choose to avoid intervention altogether. This may reflect an under-recognition or shift towards non-operative management of T1RM, particularly in patients at high risk for significant renal functional decline.

Volume

37

First Page

A159

Last Page

A160

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