Should percutaneous nephrolithotomy be performed in patients with severe chronic kidney disease? A closer look at renal function outcomes.

introductionThe effects of percutaneous nephrolithotomy (PCNL) on renal function in patients with severely impaired renal function remain uncertain. This study evaluates renal function outcomes following PCNL among this population.

methodsPatients with baseline preoperative estimated glomerular filtration rate (eGFR) < 45 and a documented eGFR after surgery were identified and included in our chronic kidney disease (CKD) ≥ 3b cohort. Study outcomes included deterioration into dialysis, ∆eGFR and the corresponding CKD stage change. For control groups, patients with preoperative CKD grades 3a, 2 and ≤ 1 were matched to the CKD ≥ 3b cohort and outcomes were compared between the groups. KEY

findings29 PCNL patients were included in the CKD ≥ 3b cohort. Median baseline preoperative eGFR was 38 (IQR 31–42) and 83% were classified as CKD 3b. Median renal function follow up was 8 months (IQR 2–13), Dialysis-free survival at 1 year was 87%, and there was no difference between preoperative and postoperative eGFR values (p = 0.97) with a ∆eGFR of 0 (IQR − 6 to 6). The CKD stage remained stable in 18 patients (62%), improved in 6 (21%), and deteriorated in 5 (17%). ∆eGFR and CKD stage changes in the CKD ≥ 3b cohort were comparable to CKD 3a and CKD 2 control groups, and better than CKD 1 control group (p = 0.02).

conclusionIn patients with moderate to severe chronic kidney disease, intermediate-term renal function after PCNL predominantly improves or remains stable, with low rates of deterioration into dialysis. These findings support a rigorous approach with PCNL for large stones management in this high-risk population.