As minimally invasive surgery advances, new techniques like PCNL and mini-PCNL are improving treatment for urolithiasis. However, there's a critical need for a standardized tool to assess outcomes, particularly stone-free rates and complications. Pentafecta measures for PCNL in CKD patients are used to evaluate the quality and outcomes of this procedure

A retrospective cross-sectional study was conducted at a tertiary care teaching hospital among the patients who underwent surgery for renal calculi in CKD patients to determine the achievement of pentafecta outcomes. We propose pentafecta measures for PCNL in CKD patients for quality assessment of this procedure, including 1) No more than 3 access tracts for surgery, 2) Complete stone clearance on the table using fluoroscopy and nephroscopy, 3) No major postoperative complications (clavien Dindo classification 3 to 5), 4) No need for auxiliary procedures for stone clearance, 5)Stable or improvement in eGFR or CKD stage, and 5 at 3 months.

Most participants (75.55%) are between 31-60 years old. Males outnumber females (71.1% vs 28.9%). Most participants (62.96%) have a history of PCNL (Percutaneous Nephrolithotomy). More than half (60%) have no co-morbidities. Hypertension is the most common co-morbidity (34.07%). The prone position is predominantly used (92.6%) compared to supine (7.4%). Mean hospital stay 2.2 +1.7 days. 86 subjects attained pentafecta among the 135 subjects. Patients in stage 4 pre-surgery experienced the best post-surgery GFR outcomes, with 40 moving to stage 3b and 17 to stage 3a, indicating improved Renal function. Stage 5 patients showed limited improvement, mostly moving to stage 4, while stages 3a and 3b had mixed results, with some 3a patients advancing to stages 2 and 1.

Overall, 86 subjects attained pentafecta among the 135 subjects. Duration of hospital stay is significantly associated with Pentafecta attainment (p < 0.001). Patients with hospital stays ≤3 days have higher Pentafecta attainment rates. The data suggests that surgical interventions may be more beneficial for patients in earlier stages of CKD, particularly those transitioning from stage 4 to stages 3b and 3a