Impact of Diabetes and Chronic Kidney Disease on Active Surveillance Outcomes for Small Renal Masses: A Cohort Study

Objective: To evaluate the impact of diabetes and chronic kidney disease (CKD) on outcomes of active surveillance (AS) in patients with small renal masses (SRMs), focusing on tumor progression, renal function decline, and the need for delayed intervention. Methods: A cohort of 55 patients with SRMs was observed from 2022 to 2024, with groups categorized by diabetes, CKD, both, or neither. Baseline demographic, clinical, and tumor data were collected. Tumor progression, renal function, and intervention rates were compared across groups using survival analysis and statistical tests. Results: Tumor progression occurred in 32.7% of the cohort, with higher rates in patients with diabetes and/or CKD (approximately 40%) than in those without (10%). Patients with diabetes or CKD showed a shorter mean time to progression and a higher need for delayed intervention (25.5% overall). Renal function declined significantly more in patients with comorbidities, with eGFR reductions of over 10 mL/min/1.73 m². Conclusion: Diabetes and CKD significantly impact AS outcomes, with increased tumor progression, faster renal function decline, and a greater likelihood of delayed intervention. Tailored AS protocols for patients with these comorbidities may improve patient outcomes.