Abstract: TH-PO1066
Radical vs. Partial Nephrectomy: Potential Impact on Kidney Functional Reserve and Long-Term Risk of CKD
Session Information
- CKD: Epidemiology, Risk Factors, and Other Conditions
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Piggott, Raymond Simon, University College Dublin Diabetes Complications Research Centre, Dublin, Leinster, Ireland
- Crooks, Josanne Patricia, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Cormican, Sarah, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Doyle, Ross, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Redahan, Lynn, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- O'Meara, Yvonne M., Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Sadlier, Denise M., Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
Background
CKD is a graded, independent risk factor for cardiovascular morbidity and mortality. Nephron-sparing surgery via partial nephrectomy (PN) preserves renal parenchyma and renal functional reserve (RFR). In contrast, radical nephrectomy (RN) removes the entire kidney, potentially increasing the risk of new-onset CKD. This study examined the impact of nephrectomy type on CKD development in patients undergoing elective renal surgery.
Methods
A retrospective cohort study of patients with baseline eGFR ≥60 mL/min/1.73 m2 undergoing elective PN or RN between 2017 and 2022 was conducted at a tertiary referral centre. Exclusion criteria included metastatic disease and abnormal contralateral kidney. The primary outcome was new-onset CKD, defined as a sustained reduction in eGFR ≤60 mL/min/1.73 m2 across two consecutive measurements at least 3 months apart within 2 years postoperatively. eGFR was calculated using the CKD-EPI equation. Propensity score matching was used to minimise baseline confounding, and Kaplan-Meier( KM) survival analysis with multivariable logistic regression evaluated associations.
Results
Of 331 nephrectomy surgeries during the study period, 170 cases were excluded, yielding a final cohort of 170 patients (PN: n=60; RN: n=110). Mean age was 59 years, with 62% male. The predominant indication was neoplasm removal (n=133). Patients undergoing RN had significantly reduced CKD-free survival compared to PN (p<0.0001; Hazard Ratio 0.3411 [95% CI 0.2–0.58]). In propensity-matched KM analysis, RN remained associated with significantly worse CKD-free survival (p<0.0001). Multivariable logistic regression identified hypertension and increasing age as independent predictors of new-onset CKD.
Conclusion
Radical nephrectomy is associated with a significantly higher risk of new-onset CKD compared to partial nephrectomy, likely reflecting greater loss of RFR. RFR is influenced not only by the volume of renal tissue removed, but also by intrinsic patient factors like age and hypertension—both of which may impair adaptive capacity through mechanisms such as nephrosclerosis and renovascular disease. These findings support nephron-sparing approaches where feasible and reinforce the importance of considering baseline factors during peri-operative planning.