CKD Linked to Worse In-Hospital Outcomes After Radical Prostatectomy

Chronic kidney disease (CKD) may be linked to worse in-hospital outcomes in patients with prostate cancer undergoing radical prostatectomy (RP), according to findings from a recent study.1

Leveraging data from the 2005–2019 National Inpatient Sample (NIS), the study found patients with prostate cancer and CKD experienced greater rates of several adverse in-hospital outcomes after RP. Of note, the effect was most pronounced for dialysis for acute kidney failure, genitourinary complications, and critical care therapies.1

“RP may be a treatment option for prostate cancer in patients with CKD. However, the effect of CKD on adverse in-hospital outcomes after RP is not well known,” Fabian Falkenbach, MD, a post-doctoral research fellow at the University of Montréal Health Center, and colleagues wrote.1

According to the American Cancer Society, other than skin cancer, prostate cancer is the most common cancer in men in the United States, and about 1 in 8 men will be diagnosed with prostate cancer during their lifetime.2 The main type of surgery for prostate cancer is a radical prostatectomy to remove the entire prostate gland plus some of the surrounding tissue, including the seminal vesicles.3

Investigators acknowledged prior research linking CKD to higher rates of complications and poor outcomes after several different surgical procedures, including 2 studies examining adverse outcomes after RP in CKD patients. However, they noted that since the publication of these reports, the management and consideration of various baseline comorbidities at RP, including CKD, may have changed, necessitating updated research.1

To determine the effect of CKD on adverse in-hospital outcomes after RP, investigators analyzed hospital discharge data from the NIS for patients with a primary diagnosis of prostate cancer who were treated with RP. Patients were stratified according to the underlying diagnosis of CKD.1

The study’s primary endpoints consisted of adverse in-hospital outcomes, defined as overall complications; rates of critical care therapy without dialysis; rates of dialysis for acute kidney failure; bleeding complications; rates of blood transfusions; cardiac complications; respiratory complications; genitourinary complications; wound complications; infectious complications; and vascular complications, identified by ICD-9 and ICD-10 codes. Investigators also assessed in-hospital mortality, prolonged length of stay, and total hospital charges (THC).1

Of 191,050 RP patients identified from the NIS, 4349 (2.3%) had CKD. Of those, 2301 (52.9%), 1416 (32.6%), and 632 (14.5%) were classified as having mild, moderate, or severe CKD, respectively. Investigators noted the CKD rate increased from 0.3% in 2005 to 5.6% in 2019 (estimated annual percentage change, 15.3%; P <.001).1

Before propensity score matching (PSM), CKD patients were older (66 vs 62 years), more frequently African American (25.9% vs 10.8%), and exhibited a higher rate of CCI ≥ 2 (33.9% vs 5.9%). After 1:3 PSM, 4349 CKD patients and 13,047 non-CKD patients remained for further analysis.1

Compared with their non-CKD counterparts, investigators noted CKD patients who underwent RP exhibited greater rates of adverse in-hospital outcomes in all examined categories, except for in-hospital mortality (all P <.05). They pointed out the absolute differences were greatest for overall complications (12.5%), length of stay > 2 days (11.8%), and blood transfusions (3.7%; all P <.001). Additionally, the median THC was $5640 higher in CKD patients relative to their non-CKD counterparts ($54,160 vs $48,520; P <.001).1

Further analysis adjusting for patient, hospital, and surgery characteristics revealed CKD independently predicted higher rates of adverse in-hospital outcomes in all examined categories, except for in-hospital mortality (all P < 0.05).1

Of note, the effect was most pronounced for dialysis for acute kidney failure (multivariable odds ratio [OR], 10.49; P <.001), genitourinary complications (OR, 2.47; P <.001), and critical care therapies (OR, 2.45; P <.001). Investigators also called attention to a dose–response relationship of CKD severity and its effect on adverse in-hospital outcomes in 7 of 14 comparisons.1

“If RP is considered in patients with severe CKD, close collaboration between urologists and nephrologists is mandatory to mitigate the detrimental effect of CKD by improved perioperative management,” investigators concluded.1

References

1. Falkenbach F, Rodriguez Peñaranda N, Longoni M, et al. The Effect of Chronic Kidney Disease on Adverse In-Hospital Outcomes at Radical Prostatectomy. International Journal of Urology. https://doi.org/10.1111/iju.70038

2. American Cancer Society. Key Statistics for Prostate Cancer. January 16, 2025. Accessed March 14, 2025. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

3. American Cancer Society. Surgery for Prostate Cancer. November 22, 2023. Accessed March 14, 2025. https://www.cancer.org/cancer/types/prostate-cancer/treating/surgery.html