This study explores the progression of chronic kidney disease (CKD) in patients with non-malignant ureteral obstruction, comparing outcomes between two primary treatments: ureteral reconstruction (UR) and ureteral stent or nephrostomy tube drainage (US/NT). The analysis includes data from 1,319 patients treated from 2006 to 2020. Patients undergoing UR, which comprised 34% of the study group, tended to be younger, more frequently female, and had lower rates of comorbid conditions like diabetes, hypertension, and cardiovascular disease than those in the US/NT group, who made up 66% of cases. Initially, CKD stages were generally lower in the UR group, with a median CKD stage of 2, compared to a median stage of 3 for US/NT patients.
Results showed that, although overall CKD progression did not differ significantly between the two groups over a 10-year period, the incidence of CKD stage advancement was notably higher in patients treated with US/NT, particularly in those starting at lower CKD stages (1 and 2). In fact, US/NT patients with a baseline CKD stage of 1 had a significantly higher risk of CKD progression, with a hazard ratio of 2.67 compared to patients who underwent UR. This suggests that UR may offer an advantage over US/NT in reducing CKD progression for patients with initially lower CKD stages, potentially making it the preferred option for maintaining kidney health in these cases.
The findings highlight the importance of intervention choice in managing non-malignant ureteral obstructions and underscore that UR may be more beneficial for patients at early CKD stages. These insights provide valuable information for physicians in discussing treatment options with patients to help mitigate CKD progression over time.
