Percutaneous nephrolithotomy in patients with chronic kidney disease

Introduction and objective: Urolithiasis can impair renal function by obstruction, infection, its association with comorbidities, high recurrence rate and need for multiple surgical interventions. Treatment of patients with chronic kidney disease (CKD) may be challenging due to the increased risk for intra- and postoperative complications, higher ASA score and association with comorbidities. The objective of this study is to compare the preoperative characteristics, efficacy and safety of PCNL in patients with normal or mildly impaired renal function and patients with chronic kidney disease. Material and methods: Prospectively collected data on 1656 PCNL procedures, performed in the Department of Urology and Nephrology at Military Medical Academy, Sofia, Bulgaria between 2011 and 2021 was analyzed. Patients were divided in 2 groups: Group 1 (1244 patients with normal or mildly impaired renal function, eGFR > 60 mL/min/1.73 m2 ) and Group 2 (412 patients with moderately impaired renal function and end stage renal disease, eGFR < 60 mL/min/1.73 m2 ) Results: Patients with CKD were more likely to be older, be female, with higher incidence of comorbidities and higher preoperative ASA score, higher rate of recurrent stones, solitary kidney and staghorn stones. PCNL efficacy after single procedure and at 3rd postoperative month was lower for CKD patients (respectively 79,6% vs 83,4%, р=0.086, and 85,9% vs 90,1%, р=0.018). There were no statistically significant differences in postoperative hemoglobin drop (14,0±10,2 vs 14,2±10,4, р=0.772) and overall complications rate (14,6% vs 12,1%, р=0.793) between the two groups. Conclusions: The results of this study suggest that PCNL is an effective and safe procedure in patients with chronic kidney disease. Although, CKD patients had larger and more complex stones, higher comorbidity rate, and higher incidence of recurrent stones and infection, these factors had no negative impact on PCNL outcomes compared to patients with normal or mildly impaired renal function.