Nephrectomy and CKD

In the recent study, “Patient and Caregiver Knowledge and Utilization of Partial Versus Radical Nephrectomy: Results of a National Kidney Foundation Survey to Assess Educational Needs of Kidney Cancer Patients and Caregivers,” published in the American Journal of Kidney Diseases, Russo et al report the results of a survey conducted by the National Kidney Foundation. The survey evaluated the kidney cancer community with regard to knowledge about the risk for chronic kidney disease associated with radical versus partial nephrectomy.

The incidence of kidney cancer is rising in part due to the increased use of abdominal imaging resulting in the early detection of small renal masses that may be kidney cancer. Clinical outcomes are equivalent when kidney masses smaller than 7cm are removed via the traditional radical nephrectomy versus “nephron-sparing” partial nephrectomy. Despite radical nephrectomy being associated with higher rates of chronic kidney disease, partial nephrectomy is underutilized for smaller sized kidney masses.

Patients and their caregivers were identified for the survey through physician referrals and online sources with 365 adult kidney cancer patients and 52 caregivers of kidney cancer patients completing surveys. Radical nephrectomy rates were high regardless of whether the kidney cancer was early or late stage, with 83% of patients with reported early stage disease undergoing radical nephrectomy. Of patients who underwent radical nephrectomy, 25% did not recall being informed about the option of partial nephrectomy, 38% were told about partial nephrectomy but the physician recommended radical nephrectomy, and 24% were told about it but were informed they were not a candidate for partial nephrectomy. An important limitation of these results is that clinical information was not available about the specific cancer diagnosis, the surgical expertise of individual physicians, or other factors that may have explained the high rate of radical nephrectomy.

Surveyed patients did not appear to recognize the bidirectional relationship between chronic kidney disease and kidney cancer, with only 56% of patients reporting they were related. Importantly, 81% of respondents reported that informational resources on kidney cancer were inadequate, providing an opportunity for the National Kidney Foundation and other Nephrology, Urology, and Oncology organizations to enhance patient and physician education about surgical options for kidney cancer and the relationship between chronic kidney disease and kidney cancer.

Craig Gordon, MD, MS
Boston Medical Center
eAJKD Contributor

Visit the National Kidney Foundation’s patient blog, Staying Healthy, for a related post.

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1 Comment on Nephrectomy and CKD

  1. What does”bidirectional relationship between chronic kidney disease and kidney cancer” mean? It sounds like it means that kidney cancer causes CKD and CKD causes kidney cancer, which is not true.

    Also, though nephrectomy causes CKD, in my experience the CKD is much less pathologic than other, more typical, causes of CKD. The decreased GFR does not seem to have the poor outcomes associated with hypertensive, diabetic and glomerlular nephritis.

    Has anyone showed improved survival or dialysis free survival with nephron sparing techniques?

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