Format

Send to

Choose Destination
Clin J Am Soc Nephrol. 2018 Nov 7;13(11):1641-1648. doi: 10.2215/CJN.06560518. Epub 2018 Sep 28.

End-Stage Kidney Disease following Surgical Management of Kidney Cancer.

Author information

1
Departments of Nephrology and r.ellis1@uq.edu.au.
2
Centre for Kidney Disease Research, Faculty of Medicine.
3
Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia.
4
Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and.
5
Urology, Princess Alexandra Hospital, Brisbane, Australia.
6
Australasian Kidney Trials Network.
7
Departments of Nephrology and.
8
Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
9
Schools of Public Health and.
10
Biomedical Sciences, and.
11
NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.

Abstract

BACKGROUND AND OBJECTIVES:

We investigated the incidence of ESKD after surgical management of kidney cancer in the Australian state of Queensland, and described patterns in the initiation of kidney replacement therapy resulting from kidney cancer across Australia.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

All newly diagnosed cases of kidney cancer in the Australian state of Queensland between January of 2009 and December of 2014 were ascertained through the Queensland Cancer Registry. There were 2739 patients included in our analysis. Patients who developed ESKD were identified using international classification of disease-10-coded hospital administrative data. Incidence rate and 3-year cumulative incidence were calculated, and multivariable Cox proportional hazards models were used to identify factors associated with ESKD. Additional descriptive analysis was undertaken of Australian population data.

RESULTS:

The incidence rate of ESKD in all patients was 4.9 (95% confidence interval [95% CI], 3.9 to 6.2) per 1000 patient-years. The 3-year cumulative incidence was 1.7%, 1.9%, and 1.0% for all patients, and patients managed with radical or partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with increased ESKD risk were age≥65 years (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.2 to 3.2), male sex (aHR, 2.3; 95% CI, 1.3 to 4.3), preoperative diabetes (aHR, 1.8; 95% CI, 1.0 to 3.3), American Society of Anesthesiologists classification ≥3 (aHR, 4.0; 95% CI, 2.2 to 7.4), socioeconomic disadvantage (aHR, 1.6; 95% CI, 0.9 to 2.7), and postoperative length of hospitalization ≥6 days (aHR, 2.1; 95% CI, 1.4 to 3.0). Australia-wide trends indicate that the rate of kidney replacement therapy after oncologic nephrectomy doubled between 1995 and 2015, from 0.3 to 0.6 per 100,000 per year.

CONCLUSIONS:

In Queensland between 2009 and 2014, one in 53 patients managed with radical nephrectomy and one in 100 patients managed with partial nephrectomy developed ESKD within 3 years of surgery.

PODCAST:

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_09_28_CJASNPodcast_18_1_.mp3.

KEYWORDS:

Anesthesiologists; Incidence; International Classification of Diseases; Kidney Failure, Chronic; Kidney Neoplasms; Nephrectomy; Proportional Hazards Models; Registries; Renal Replacement Therapy; chronic kidney disease; diabetes mellitus; end-stage kidney disease; glomerular filtration rate; hospitalization; kidney cancer; renal cell carcinoma

PMID:
30266837
PMCID:
PMC6237064
[Available on 2019-11-07]
DOI:
10.2215/CJN.06560518

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center