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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] [What about the content of this article? (0)] [Affiliation(s)] [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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