Chronic kidney disease status and intraoperative adverse events during partial nephrectomy: a propensity-score matched study

Background: Intraoperative adverse events (iAEs) are increasingly recognized as critical indicators of surgical quality and predictors of postoperative morbidity. However, the impact of pre-existing chronic kidney disease (CKD) on the occurrence and severity of iAEs during minimally invasive partial nephrectomy (PN) remains poorly defined. This study aimed to evaluate the association between CKD status and iAEs in patients undergoing minimally invasive PN. Methods: This multicenter retrospective analysis used prospectively maintained databases from three academic centers, including consecutive patients who underwent laparoscopic or robot-assisted PN between 2014 and 2024. iAEs were identified and graded according to the European Association of Urology intraoperative adverse incident classification. Propensity score matching (PSM) (1:2) was performed to balance baseline characteristics between patients with and without CKD. Univariable and multivariable Firth's penalized logistic regression analyses were used to identify independent risk factors for iAEs. Results: . 9.8%, P=0.008). Multivariate analysis identified CKD [odds ratio (OR) 1.292, 95% confidence interval (CI): 1.043-4.028, P=0.01], higher RENAL Nephrometry Score (RNS) (OR 1.173, 95% CI: 1.019-1.376, P=0.03), and Mayo Adhesive Probability (MAP) score (OR 2.103, 95% CI: 1.173-4.954, P=0.01) as independent predictors of iAEs. Conclusions: Pre-existing CKD is independently associated with an increased risk and greater severity of iAEs during minimally invasive PN. Incorporating CKD status into preoperative risk stratification may enhance intraoperative safety and inform surgical planning.