Supplementary Material for: Percutaneous Nephrolithotomy in Patients with Chronic Kidney Disease: A Systematic Review

<b><i>Background:</i></b> Renal calculi in chronic kidney disease (CKD) are not uncommon. Percutaneous nephrolithotomy (PCNL) is a standard treatment for large renal calculi. PCNL in CKD has been a subject of debate as it may improve the renal function with stone clearance but may be associated with an increased complication rate. Studying the impact of PCNL in CKD patients is of utmost significance. <b><i>Objective:</i></b> The aim of the study was to evaluate the efficacy and safety of PCNL in patients with renal insufficiency in order to provide clinicians expected outcomes to effectively counsel patients. <b><i>Methods:</i></b> We performed a systematic review of clinical trials reporting the outcomes of PCNL in CKD patients. The search was performed in MEDLINE, EMBASE, Cochrane Library, CINAHL, Google Scholar, and Web of Science. All studies with a minimum of 15 patients carried out in the last 20 years were selected. A total of 13 studies involving 2,192 patients were included for final analysis. The pre-operative and post-operative renal function was compared. Post-procedure complications were analysed. <b><i>Evidence Analysis:</i></b> The majority of patients in all studies except one had either improvement or stabilization in renal function. The complication rate was 31.9%, which was more than that in patients with normal renal function. <b><i>Conclusion:</i></b> Our review suggested that the majority of the patients of renal calculus with renal insufficiency are benefitted with PCNL in improving or preserving the renal function. But the post-operative complications are more in CKD and increases as the severity of renal insufficiency increases.