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

INTRODUCTION: The 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. METHODS: Patients 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 FINDINGS: 29 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). CONCLUSION: In 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.