Data Sheet 1_Comparative outcomes of ureteroscopy and percutaneous nephrolithotomy in CKD patients with renal calculi: a propensity-matched cohort study.docx

BackgroundKidney stones frequently coexist with chronic kidney disease (CKD), sharing common risk factors and leading to adverse outcomes. While percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) are both effective treatment options, the safety of PCNL has been well-established in CKD patients, whereas the safety profile of URS remains less clear.
MethodsA retrospective cohort study using the TriNetX database was conducted to compare outcomes in CKD patients undergoing URS or PCNL. Patients aged ≥18 years with a diagnosis of renal stones and CKD were included, excluding those on dialysis. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was the 5-year rate of major adverse kidney events (MAKE), a composite of mortality, dialysis initiation, and worsened renal function. Secondary outcomes included all-cause mortality and dialysis dependence. Subgroup and sensitivity analyses were performed to ensure robustness.
ResultsOf 5,470 eligible patients, 837 underwent URS and 4,633 underwent PCNL, with 723 patients matched in each group post-PSM. There was no significant difference in MAKE between URS and PCNL (HR 0.93; 95% CI 0.68–1.28; p = 0.6952). All-cause mortality (HR 0.98; 95% CI 0.70–1.36; p = 0.9125) and dialysis dependence (HR 0.57; 95% CI 0.23–1.38; p = 0.2128) were also similar. The limitation of this study is the lack of data on stone size and location.
ConclusionIn CKD patients with renal stones, URS demonstrated comparable safety and efficacy compared to PCNL, with no significant differences in MAKE, all-cause mortality, or dialysis dependence over 5 years. However, the lack of information regarding stone size, anatomical location, and procedure-specific details (e.g., device use or surgical technique) is a major limitation of our study.

背景：肾结石常与慢性肾脏病（chronic kidney disease, CKD）共存，二者拥有共同的危险因素，并可导致不良临床结局。经皮肾镜取石术（percutaneous nephrolithotomy, PCNL）与输尿管镜碎石术（ureteroscopy, URS）均为有效的肾结石治疗手段，目前PCNL用于CKD患者的安全性已得到充分证实，但URS的安全性特征仍不甚明确。
方法：本研究依托TriNetX数据库开展回顾性队列研究，旨在对比接受URS或PCNL治疗的CKD患者的临床结局。研究纳入年龄≥18岁、确诊肾结石且合并CKD的患者，排除接受透析治疗者。通过倾向得分匹配（propensity score matching, PSM）平衡两组患者的基线特征。本研究的主要结局为5年内主要不良肾脏事件（major adverse kidney events, MAKE）发生率，该复合终点包括全因死亡、启动透析以及肾功能恶化。次要结局包括全因死亡率与透析依赖率。为确保研究结果的稳健性，本研究开展了亚组分析与敏感性分析。
结果：在5470例符合入组标准的患者中，837例接受URS治疗，4633例接受PCNL治疗；经PSM后，两组各匹配得到723例患者。URS组与PCNL组的MAKE发生率无显著差异（风险比HR=0.93，95%置信区间CI：0.68~1.28，P=0.6952）。两组的全因死亡率（HR=0.98，95%CI：0.70~1.36，P=0.9125）与透析依赖率（HR=0.57，95%CI：0.23~1.38，P=0.2128）亦无显著差异。本研究的局限性在于缺乏结石大小与位置相关的数据。
结论：对于合并肾结石的CKD患者，URS与PCNL的安全性与有效性相当，术后5年内的MAKE发生率、全因死亡率及透析依赖率均无显著差异。但本研究仍存在主要局限性：未收集结石大小、解剖位置以及手术相关细节（如器械使用、手术操作方式）相关数据。