R ELLIS1,2,3, D EDEY2, S DEL VECCHIO1,2, M MCSTEA4, C HAWLEY1,2,4, D JOHNSON1,2,4, D VESEY1,2, C MORAIS1,2, S JORDAN3,5, R FRANCIS1,2, S WOOD1,2, G GOBE1,2,6,
1Princess Alexandra Hospital, Brisbane, Australia, 2Centre for Kidney Disease Research, University of Queensland Faculty of Medicine, Translational Research Institute, Brisbane, Australia, 3QIMR Berghofer Medical Research Institute, Brisbane, Australia, 4Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia, 5School of Public Health, University of Queensland, Brisbane, Australia, 6NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
Aim: To evaluate the burden of and determine possible risk-factors for end-stage kidney disease (ESKD) following surgical management of kidney tumours in Queensland.
Background: Surgical resection of all or part of a kidney is the mainstay of management for kidney masses suspicious for malignancy. This can be associated with an increased risk of chronic kidney disease (CKD).
Methods: All new cases of kidney cancer diagnosed in Queensland between January 2009 and December 2014 were ascertained through the Queensland Oncology Repository. Patients who developed ESKD following surgery were identified using ICD-10 coded hospital administrative data. Patients with preoperative ESKD were not included. Multivariable Cox proportional hazards models were used to identify characteristics associated with higher risk of ESKD. Incidence rate and three year cumulative incidence were also calculated.
Results: Of 2,739 included patients, 68 developed ESKD over a median follow-up period of 59.4 postoperative months; 15 were known to have moderately-severe (approximately stage 4) CKD preoperatively. The incidence rate of ESKD in all patients was 4.9 (95%CI: 3.9-6.2) per 1,000 patient-years. Three-year cumulative incidence was 1.7%, 1.9% and 1.0% for all patients, and patients managed with radical and partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with ESKD were age ≥65 years-old (aHR: 2.0, 95%CI: 1.2-3.2), male sex (aHR: 2.3, 95%CI: 1.3-4.3), preoperative diabetes (aHR: 1.8, 95%CI: 1.0-3.3), American Society of Anesthesiologists class ≥3 (aHR: 4.0, 95%CI: 2.2-7.4), and socioeconomic disadvantage (aHR: 1.6, 95%CI: 0.9-2.7).
Conclusions: Approximately 1 in 59 patients managed surgically for kidney cancer in Queensland developed ESKD within three years of surgery. Typical risk factors for CKD were associated with ESKD in the present study.
Robert Ellis is currently completing his MD and PhD studies at the University of Queensland. His thesis is focused on identifying risk factors for the development of deficits in kidney function following oncological nephrectomy.