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Predictors of new-onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: an Australian population-based analysis
journal contribution
posted on 2018-06-01, 00:00 authored by Thomas Ahn, Robert J Ellis, Vicki WhiteVicki White, Damien M Bolton, Michael D Coory, Ian D Davis, Ross S Francis, Graham G Giles, Glenda C Gobe, Carmel M Hawley, David W Johnson, David J T Marco, Megan McStea, Rachel E Neale, Elaine M Pascoe, Simon T Wood, Susan J Jordan, IMPROVE investigatorsBACKGROUND: New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS: There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS: Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION: Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.
History
Journal
Journal of surgical oncologyVolume
117Issue
7Pagination
1597 - 1610Publisher
WileyLocation
Chichester, Eng.Publisher DOI
eISSN
1096-9098Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2018, WileyUsage metrics
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No categories selectedKeywords
chronic kidney diseaseestimated glomerular filtration ratenephrectomyrenal cell carcinomaAgedAustraliaCarcinoma, Renal CellCohort StudiesFemaleFollow-Up StudiesGlomerular Filtration RateHumansKidney NeoplasmsMaleMiddle AgedNeoplasm StagingPostoperative ComplicationsRenal Insufficiency, ChronicRisk FactorsWatchful WaitingScience & TechnologyLife Sciences & BiomedicineOncologySurgeryPARTIAL NEPHRECTOMYRADICAL NEPHRECTOMYFUNCTIONAL OUTCOMESRISK-FACTORSTUMORSSURVIVALIMPACTVOLUMEEQUATIONIMPROVE investigators
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