End-stage renal disease (ESRD) develops in 1.7% of patients within 3 years of undergoing nephrectomy for kidney cancer, new data show.
In a study of 2739 patients, the 3-year cumulative incidence of ESRD following nephrectomy was 1.9% (1 in 53 patients) who underwent radical nephrectomy (RN) and 1.0% (1 in 100 patients) who underwent partial nephrectomy (PN), Robert J. Ellis, BHSc, from Princess Alexandra Hospital in Brisbane, Australia, and colleagues reported online ahead of print in the Clinical Journal of the American Society of Nephrology.
“This study has highlighted that patients undergoing nephrectomy are subjected to potential harms, which need to be carefully balanced against benefits of surgery,” Dr Ellis’ team concluded.
Besides preoperative kidney disease, risk factors for ESRD following nephrectomy included older age, male sex, preoperative diabetes, longer post-operative length of hospital stay, higher American Society of Anesthesiologists (ASA) classification, and socioeconomic disadvantage.
In adjusted analyses, preoperative kidney disease was associated with a 15-fold increased risk of ESRD, according to the investigators. Patients aged 65 years or older had a 2-fold higher risk of ESRD compared with younger patients. Male sex was associated with a 2.3-fold higher risk of ESRD compared with female sex. Preoperative diabetes increased ESRD risk by 1.8-fold. A post-operative hospital stay of 6 days or longer was associated with a 2.1-fold increased risk of ESRD versus a stay of 1 to 5 days. Compared with an ASA score of 1 to 2, a score of 3 or higher was associated with a 4-fold increased risk of ESRD.
“With these possible risk factors in mind,” the authors wrote, “preoperative and ongoing screening for at-risk nephrectomy patients may improve patient outcomes, allowing for earlier appropriate referral to a nephrology, with subsequent implementation of a multidisciplinary approach to ongoing management decisions.”
Ellis RJ, Edey DP, Del Vecchio SJ, et al. End-stage kidney disease following surgical management of kidney cancer. Clin J Am Soc Nephrol. 2018; published online ahead of print.