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Ishihara H, Nemoto Y, Tachibana H, Ikeda T, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Shimmura H, Hashimoto Y, Kondo T, Takagi T. Association Between Kidney Function and Outcomes Following Immune Checkpoint Inhibitor-Based Combination Therapy in Patients With Advanced Renal Cell Carcinoma. Clin Genitourin Cancer 2024; 22:549-557.e5. [PMID: 38281878 DOI: 10.1016/j.clgc.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND It remains unclear whether kidney function affects outcomes following immune checkpoint inhibitor (ICI)-based combination therapy for advanced renal cell carcinoma (RCC). METHODS We retrospectively evaluated data of 167 patients with advanced RCC, including 98 who received ICI dual combination therapy (ie, immunotherapy [IO]-IO) and 69 who received ICI combined with tyrosine kinase inhibitor (TKI) (ie, IO-TKI). In each regimen, treatment profiles were assessed according to the grade of chronic kidney disease (CKD) as defined by the KDIGO 2012 criteria. RESULTS Of the 98 patients who received IO-IO, 31 (32%), 30 (31%), 15 (15%), and 22 (22%) had CKD G1/2, G3a, G3b, and G4/5, respectively. Of the 69 patients who received IO-TKI, 18 (26%), 25 (36%), and 26 (38%) had G1/2, G3a, and G3b/4/5, respectively. Regarding efficacy, progression-free survival, overall survival, or objective response rate was not different according to the CKD grade in both treatment groups (P > .05). Regarding safety, the rate of adverse events, treatment interruption, or corticosteroid administration was not different according to the CKD grade in the IO-IO group (P > .05), whereas in the IO-TKI group, the incidence of grade ≥ 3 adverse events were significantly higher (P = .0292), and the rates of ICI interruption (P = .0353) and corticosteroid administration (P = .0685) increased, according to the CKD grade. CONCLUSION There is a differential safety but comparable efficacy profile between the IO-IO and IO-TKI regimens in patients with CKD. Further prospective studies are required to confirm these findings.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Yuki Nemoto
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Adachi-ku, Tokyo, Japan; Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
| | | | - Takashi Ikeda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Oh SW, Byun SS, Kim JK, Jeong CW, Kwak C, Hwang EC, Kang SH, Chung J, Kim YJ, Ha YS, Hong SH. Machine learning models for predicting the onset of chronic kidney disease after surgery in patients with renal cell carcinoma. BMC Med Inform Decis Mak 2024; 24:85. [PMID: 38519947 PMCID: PMC10960396 DOI: 10.1186/s12911-024-02473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Patients with renal cell carcinoma (RCC) have an elevated risk of chronic kidney disease (CKD) following nephrectomy. Therefore, continuous monitoring and subsequent interventions are necessary. It is recommended to evaluate renal function postoperatively. Therefore, a tool to predict CKD onset is essential for postoperative follow-up and management. METHODS We constructed a cohort using data from eight tertiary hospitals from the Korean Renal Cell Carcinoma (KORCC) database. A dataset of 4389 patients with RCC was constructed for analysis from the collected data. Nine machine learning (ML) models were used to classify the occurrence and nonoccurrence of CKD after surgery. The final model was selected based on the area under the receiver operating characteristic (AUROC), and the importance of the variables constituting the model was confirmed using the shapley additive explanation (SHAP) value and Kaplan-Meier survival analyses. RESULTS The gradient boost algorithm was the most effective among the various ML models tested. The gradient boost model demonstrated superior performance with an AUROC of 0.826. The SHAP value confirmed that preoperative eGFR, albumin level, and tumor size had a significant impact on the occurrence of CKD after surgery. CONCLUSIONS We developed a model to predict CKD onset after surgery in patients with RCC. This predictive model is a quantitative approach to evaluate post-surgical CKD risk in patients with RCC, facilitating improved prognosis through personalized postoperative care.
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Affiliation(s)
- Seol Whan Oh
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 06591, Seoul, Korea
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, 06591, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, 61469, Gwangju, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, 02841, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, 10408, Goyang, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University College of Medicine, 28644, Cheongju, Korea
- Department of Urology, College of Medicine, Chungbuk National University, 28644, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, 41404, Daegu, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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3
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Zhang S, Jin D, Zhang Y, Wang T. Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy. BMC Urol 2023; 23:156. [PMID: 37794388 PMCID: PMC10552238 DOI: 10.1186/s12894-023-01325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is understood about this possibility among kidney surgical populations. This study aimed to elucidate the incidence of AKD after partial nephrectomy and risk factors that promote the AKI to AKD transition. METHODS From January 2010 to January 2020, this study retrospectively collected a dataset of consecutive patients with renal masses undergoing partial nephrectomy in 4 urological centers. Cox proportional regression analyses were adopted to identify risk factors that promoted the AKI to AKD transition. To avoid overfitting, the results were then verified by logistic least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then constructed and validated for AKI to AKD transition prediction. RESULTS AKI and AKD occurred in 228 (21.4%) and 42 (3.9%) patients among a total of 1062 patients, respectively. In patients with AKI, multivariable Cox regression analysis and LASSO regression identified that age (HR 1.078, 1.029-1.112, p < 0.001), baseline eGFR (HR 1.015, 1.001-1.030, p < 0.001), RENAL score (HR1.612, 1.067-2.437, p = 0.023), ischemia time > 30 min (HR 7.284, 2.210-23.999, p = 0.001), and intraoperative blood loss > 300ml (HR 8.641, 2.751-27.171, p < 0.001) were risk factors for AKD transition. These five risk factors were then integrated into a nomogram. The nomogram showed excellent discrimination, calibration, and clinical net benefit ability. CONCLUSION Around 3.9% patients following partial nephrectomy would transit from AKI to AKD. Intraoperative blood loss and ischemia time need to be diminished to avoid on-going functional decline. Our nomogram can accurately predict the transition from AKI to AKD.
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Affiliation(s)
- Sizhou Zhang
- Department of Urology, People's Hospital of Hechuan Chongqing, Chongqing, P.R. China
| | - Dachun Jin
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
- Department of Urology, Daping Hospital/Army Medical Center, Army Medical University, Chongqing, P.R. China
| | - Yuanfeng Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
| | - Tianhui Wang
- Department of Urology, People's Hospital of Fengjie, Chongqing, P.R. China.
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4
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Kadatane SP, Satariano M, Massey M, Mongan K, Raina R. The Role of Inflammation in CKD. Cells 2023; 12:1581. [PMID: 37371050 DOI: 10.3390/cells12121581] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) affects many adults worldwide. Persistent low-grade inflammation is a substantial factor in its development and progression and has correlated with increased mortality and cardiovascular problems. This low-grade inflammation is a product of dysregulation of the normal balance between pro- and anti-inflammatory markers. Various factors such as increased innate immune system activation, reactive oxygen species production, periodontal disease, dysregulation of anti-inflammatory systems and intestinal dysbiosis result in the dysregulation of this balance. Furthermore, this low-grade inflammation has down-effects such as hypertension, renal fibrosis and acceleration of renal function decline. Moreover, low-grade inflammation over time has been linked to malignancy in CKD. As CKD progresses, many patients require dialysis, which has a negative bidirectional relationship with persistent inflammation. Treatment options for inflammation in CKD are vast, including cytokine inhibitors, statins and diets. However, more research is needed to create a standardized management plan. In this review, we will examine the normal physiology of the kidney and its relationship with the immune system. We will then delve into the pathology behind persistent inflammation, the various causes of inflammation, the downstream effects of inflammation, dialysis and potential treatments for inflammation in CKD.
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Affiliation(s)
| | - Matthew Satariano
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Michael Massey
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Kai Mongan
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH 44302, USA
- Department of Nephrology, Akron Children's Hospital, Akron, OH 44308, USA
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5
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Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, Klatte T, García-Chairez LR, González-Colmenero AD, Pallares-Méndez R, Cervantes-Miranda DE, Plata-Huerta HH, Rodriguez-Gutierrez R, Gutiérrez-González A. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis. Urol Oncol 2023; 41:113-124. [PMID: 36642639 DOI: 10.1016/j.urolonc.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/17/2022] [Accepted: 11/27/2022] [Indexed: 01/16/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.
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Affiliation(s)
- Mario Ochoa-Arvizo
- Edinburgh Medical School: Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Urology, IRCSS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Mariano García-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karla M Santos-Santillana
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Tobias Klatte
- Department of Urology, Charite-Universitaetmedizin, Berlin, Germany
| | - Luis R García-Chairez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro D González-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rigoberto Pallares-Méndez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniel E Cervantes-Miranda
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hiram H Plata-Huerta
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene- Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Gutiérrez-González
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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6
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Hu M, Wang Q, Liu B, Ma Q, Zhang T, Huang T, Lv Z, Wang R. Chronic Kidney Disease and Cancer: Inter-Relationships and Mechanisms. Front Cell Dev Biol 2022; 10:868715. [PMID: 35663394 PMCID: PMC9158340 DOI: 10.3389/fcell.2022.868715] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/26/2022] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) has been recognized as an increasingly serious public health problem globally over the decades. Accumulating evidence has shown that the incidence rate of cancer was relatively higher in CKD patients than that in general population, which, mechanistically, may be related to chronic inflammation, accumulation of carcinogenic compounds, oxidative stress, impairment of DNA repair, excessive parathyroid hormone and changes in intestinal microbiota, etc. And in patients with cancer, regardless of tumor types or anticancer treatment, it has been indicated that the morbidity and incidence rate of concomitant CKD was also increased, suggesting a complex inter-relationship between CKD and cancer and arousing increasing attention from both nephrologists and oncologists. This narrative review focused on the correlation between CKD and cancer, and underlying molecular mechanisms, which might provide an overview of novel interdisciplinary research interests and the potential challenges related to the screening and treatment of CKD and cancer. A better understanding of this field might be of help for both nephrologists and oncologists in the clinical practice.
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Affiliation(s)
- Mengsi Hu
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qianhui Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bing Liu
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiqi Ma
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tingwei Zhang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tongtong Huang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhimei Lv
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Zhimei Lv, ; Rong Wang,
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Zhimei Lv, ; Rong Wang,
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7
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Li X, Li Z, Wu X, Zhang M, Xu L, Hao X, Li H, Qiao P, Wang W. Serum uric acid variability increases the risk of postoperative chronic kidney disease in patients with renal cell carcinoma after radical nephrectomy. Urol Oncol 2021; 39:500.e1-500.e7. [PMID: 34187751 DOI: 10.1016/j.urolonc.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Serum uric acid (SUA) level is associated with the progression of chronic kidney disease (CKD). However, little is known about the predictive value of SUA variability for postoperative CKD in patients with renal cell carcinoma after radical nephrectomy. We aimed to investigate the association of SUA variability with postoperative CKD in this population. METHOD 85 patients with preoperative estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m2 were enrolled in this single-center retrospective study and followed up for at least 6 months. Intra-individual SUA variability was defined as the standard deviation (SD) of SUA and the patients were stratified into three groups according to the tertiles of SUA SD (the lower, middle and upper tertile). The association of SUA variability with postoperative CKD, defined as an eGFR<60 ml/min/1.73m2, was analyzed by Cox proportional hazard models and Kaplan-Meier analyses. RESULTS After a median follow-up time of 24(10-43) months, 44(51.7%) patients developed postoperative CKD. Kaplan-Meier curves showed that patients in the lower tertile had a longer CKD-free survival time [median CKD-free survival time 74(52.2-95.8) months] than those in the middle tertile [38(19.2-56.8) months] and upper tertile [21(17.9-24.1) months] (overall generalized Wilcoxon test: P=0.001; lower vs middle tertile: P=0.001; lower vs upper tertile: P<0.001). Adjusted Cox analyses indicated that increasing SUA SD tertiles were associated with a higher risk of postoperative CKD independent of baseline SUA, mean SUA during follow-up and other confounding variables. Compared with patients in the lower tertile, the risk for developing CKD increased by 4.6-fold for patients in the middle tertile and 7.9-fold in the upper tertile, respectively. CONCLUSION Increasing SUA variability was associated with an increased risk of postoperative CKD in patients with renal cell carcinoma after radical nephrectomy.
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Affiliation(s)
- Xin Li
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhen Li
- Clinical Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojing Wu
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Muyin Zhang
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xu Hao
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Li
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Panpan Qiao
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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8
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Hu XY, Liu DW, Qiao YJ, Zheng X, Duan JY, Pan SK, Liu ZS. Development and Validation of a Nomogram Model to Predict Acute Kidney Disease After Nephrectomy in Patients with Renal Cell Carcinoma. Cancer Manag Res 2020; 12:11783-11791. [PMID: 33235506 PMCID: PMC7680605 DOI: 10.2147/cmar.s273244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To develop and validate a nomogram model to predict the occurrence of acute kidney disease (AKD) after nephrectomy. Patients and Methods A retrospective cohort including 378 patients with renal cell carcinoma (RCC) who had undergone radical or partial nephrectomy between March 2013 and December 2017 at the First Affiliated Hospital of Zhengzhou University was analyzed. Of these, patients who had undergone surgery in an earlier period of time formed the training cohort (n=265) for nomogram development, and those who had undergone surgery thereafter formed the validation cohort (n=113) to confirm the model's performance. The incidence rate of AKD was measured. Univariate and multivariate logistics regression analysis was used to estimate the independent risk factors associated with AKD. The independent risk factors were incorporated into the nomogram. The accuracy and utility of the nomogram were evaluated by calibration curve and decision curve analysis, respectively. Results Overall, AKD occurred in 27.5% and 28.3% of patients in the training and validation cohorts, separately. The final nomogram included surgery approach, Charlson comorbidity index (CCI), and the decrement of eGFR. This model achieved good concordance indexes of 0.78 (95% CI=0.71-0.84) and 0.76 (95% CI=0.67-0.86) in the training and validation cohorts, respectively. The calibration curves and decision curve analysis (DCA) demonstrated the accuracy and the clinical usefulness of the proposed nomogram, separately. Conclusion The nomogram accurately predicts AKD after nephrectomy in patients with RCC. The risk for patients' progress into AKD can be determined, which is useful in guiding clinical decisions.
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Affiliation(s)
- Xiao-Ying Hu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
| | - Dong-Wei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
| | - Ying-Jin Qiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
| | - Xuan Zheng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, People's Republic of China
| | - Jia-Yu Duan
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
| | - Shao-Kang Pan
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
| | - Zhang-Sou Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, People's Republic of China.,Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, People's Republic of China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, People's Republic of China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou 450052, People's Republic of China
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9
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Ellis RJ, Del Vecchio SJ, Gallagher KMJ, Aliano DN, Barber N, Bolton DM, Chew ETS, Coombes JS, Coory MD, Davis ID, Donaldson JF, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Laird A, Leung S, Malki M, Marco DJT, McNeill AS, Neale RE, Ng KL, Phipps S, Stewart GD, White VM, Wood ST, Jordan SJ. A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation. J Am Soc Nephrol 2020; 31:1107-1117. [PMID: 32238473 DOI: 10.1681/asn.2019121328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed. METHODS To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk). RESULTS Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts. CONCLUSIONS Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
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Affiliation(s)
- Robert J Ellis
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia .,Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Sharon J Del Vecchio
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Kevin M J Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Danielle N Aliano
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Logan Hospital, Logan, Queensland, Australia
| | - Neil Barber
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Damien M Bolton
- Austin Urology, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jeff S Coombes
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian D Davis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - James F Donaldson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Ross S Francis
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham G Giles
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Alexander Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Manar Malki
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - David J T Marco
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alan S McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel E Neale
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keng L Ng
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Simon Phipps
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom.,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Susan J Jordan
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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10
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Ali S, Ahn T, Papa N, Perera M, Teloken P, Coughlin G, Wood ST, Roberts MJ. Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data. ANZ J Surg 2019; 90:48-52. [PMID: 31478323 DOI: 10.1111/ans.15385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
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Affiliation(s)
- Stephen Ali
- Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Teloken
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Geoffrey Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia
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11
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Neale RE, Wood ST, Jordan SJ. Tumor size and postoperative kidney function following radical nephrectomy. Clin Epidemiol 2019; 11:333-348. [PMID: 31191028 PMCID: PMC6511655 DOI: 10.2147/clep.s197968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic kidney disease (CKD) following nephrectomy for kidney tumors is common, and both patient and tumor characteristics may affect postoperative kidney function. Several studies have reported that surgery for large tumors is associated with a lower likelihood of postoperative CKD, but others have reported CKD to be more common before surgery in patients with large tumors. Objective: The aim of this study was to clarify inconsistencies in the literature regarding the prognostic significance of tumor size for postoperative kidney function. Study design and setting: We analyzed data from 944 kidney cancer patients managed with radical nephrectomy between January 2012 and December 2013, and 242 living kidney donors who underwent surgery between January 2011 and December 2014 in the Australian states of Queensland and Victoria. Multivariable logistic regression was used to assess the primary outcome of CKD upstaging. Structural equation modeling was used to evaluate causal models, to delineate the influence of patient and tumor characteristics on postoperative kidney function. Results: We determined that a significant interaction between age and tumor size (P=0.03) led to the observed inverse association between large tumor size and CKD upstaging, and was accentuated by other forms of selection bias. Subgrouping patients by age and tumor size demonstrated that all patients aged ≥65 years were at increased risk of CKD upstaging, regardless of tumor size. Risk of CKD upstaging was comparable between age-matched living donors and kidney cancer patients. Conclusion: Larger tumors are unlikely to confer a protective effect with respect to postoperative kidney function. The reason for the previously reported inconsistency is likely a combination of the analytical approach and selection bias.
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Affiliation(s)
- Robert J Ellis
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, VIC, Australia
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University and Eastern Health, Melbourne, VIC, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Glenda C Gobe
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Simon T Wood
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Susan J Jordan
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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12
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Niu SW, Liang PI, Lin MY, Yeh SM, Zhen YY, Chang YH, Huang PC, Hung CC, Kuo IC, Lin HYH, Kuo MC, Li WM, Huang CN, Wu WJ, Chen LT, Chiu YW, Hwang SJ. Predominant global glomerulosclerosis in patients of upper urinary tract urothelial carcinoma with pre-existing renal function impairment is a predictor of poor renal outcomes. BMC Cancer 2019; 19:337. [PMID: 30961555 PMCID: PMC6454684 DOI: 10.1186/s12885-019-5414-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 02/27/2019] [Indexed: 12/19/2022] Open
Abstract
Background Incidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy. Methods Totally 193 renal cancer patients, including 132 UTUC and 61 RCC, were studied to clarify whether the pathological changes of the kidney remnant removed from nephrectomy and the clinical factors might predict the risk of ESRD. Renal tubulointerstitial (TI) score and global glomerulosclerosis (GGS) rate were examined by one pathologist and two nephrologists independently under same histopathological criteria. Results The glomerular filtration rates at the time of surgery were lower in UTUC than RCC groups (p < 0.001). Average GGS score and average TI rate were higher in UTUC than in RCC groups (p < 0.001; p < 0.001). Competitive risk factor analysis revealed that abnormal GGS rate not related to age, predominant in UTUC with pre-existing renal function impairment, was a histopathological predictor of poor renal outcomes (creatinine doubling or ESRD) within 5 years in UTUC patients. Conclusion Pre-existing renal function and pathological change of kidney remnant in both UTUC and RCC have the value for prediction of renal outcomes. Electronic supplementary material The online version of this article (10.1186/s12885-019-5414-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheng-Wen Niu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Meng Yeh
- Yozen clinic, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Yi Zhen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan
| | - Yu-Han Chang
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pin-Chia Huang
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chi Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Nung Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, 80708, Kaohsiung, Taiwan. .,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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13
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Marco DJT, Neale RE, Wood ST, Jordan SJ. Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e581-e591. [PMID: 30975606 DOI: 10.1016/j.clgc.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy. PATIENTS AND METHODS All patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m2) at 12 months after nephrectomy. RESULTS Older age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias. CONCLUSION Patient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.
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Affiliation(s)
- Robert J Ellis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia; Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia; Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - David J T Marco
- University of Melbourne, Melbourne, Australia; Centre for Palliative Care, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
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14
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Ellis RJ, Edey DP, Del Vecchio SJ, McStea M, Campbell SB, Hawley CM, Johnson DW, Morais C, Jordan SJ, Francis RS, Wood ST, Gobe GC. End-Stage Kidney Disease following Surgical Management of Kidney Cancer. Clin J Am Soc Nephrol 2018; 13:1641-1648. [PMID: 30266837 PMCID: PMC6237064 DOI: 10.2215/cjn.06560518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
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.
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Affiliation(s)
- Robert J. Ellis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Daniel P. Edey
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Sharon J. Del Vecchio
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Megan McStea
- Australasian Kidney Trials Network
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | | | - Carmel M. Hawley
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - David W. Johnson
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Christudas Morais
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Susan J. Jordan
- Schools of Public Health and
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Ross S. Francis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Simon T. Wood
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Glenda C. Gobe
- Centre for Kidney Disease Research, Faculty of Medicine
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Cancer Alliance Queensland
- Departments of Nephrology and
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Schools of Public Health and
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
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15
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Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome. J Immunol Res 2018; 2018:2180373. [PMID: 30271792 PMCID: PMC6146775 DOI: 10.1155/2018/2180373] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 12/13/2022] Open
Abstract
Persistent, low-grade inflammation is now considered a hallmark feature of chronic kidney disease (CKD), being involved in the development of all-cause mortality of these patients. Although substantial improvements have been made in clinical care, CKD remains a major public health burden, affecting 10–15% of the population, and its prevalence is constantly growing. Due to its insidious nature, CKD is rarely diagnosed in early stages, and once developed, its progression is unfortunately irreversible. There are many factors that contribute to the setting of the inflammatory status in CKD, including increased production of proinflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, altered metabolism of adipose tissue, and last but not least, gut microbiota dysbiosis, an underestimated source of microinflammation. In this scenario, a huge step forward was made by the increasing progression of omics approaches, specially designed for identification of biomarkers useful for early diagnostic and follow-up. Recent omics advances could provide novel insights in deciphering the disease pathophysiology; thus, identification of circulating biomarker panels using state-of-the-art proteomic technologies could improve CKD early diagnosis, monitoring, and prognostics. This review aims to summarize the recent knowledge regarding the relationship between inflammation and CKD, highlighting the current proteomic approaches, as well as the inflammasomes and gut microbiota dysbiosis involvement in the setting of CKD, culminating with the troubling bidirectional connection between CKD and renal malignancy, raised on the background of an inflammatory condition.
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