Chronic Kidney Disease in Cancer Patients: An Independent Predictor of Cancer-Specific Mortality

Na, Sun Young; Sung, Ji Yoon; Chang, Jae Hyun; Kim, Sejoong; Lee, Hyun Hee; Park, Yeon Ho; Chung, Wookyung; Oh, Kook‐Hwan; Jung, Ji Yong

doi:10.1159/000323740

Cited by 89 publications

(91 citation statements)

References 78 publications

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“…Previous studies suggested kidney and urinary tract cancers are high risk for renal dysfunction due to the tumor location (obstruction, and/or reduction of nephron mass) [13,[15][16][17]. The prevalence of CKD in genitourinary cancers were reported 8.7-21.4% [15,18]. In the present study, the prevalence of CKD in MIBC patients was 37%, which is a strong bias in our cohort.…”

Section: Discussioncontrasting

confidence: 42%

“…Patients with renal impairment are at risk of CVD [14], but the reason for the strong association between CKD and poor recurrence-free survival is not clear. Previous studies suggested kidney and urinary tract cancers are high risk for renal dysfunction due to the tumor location (obstruction, and/or reduction of nephron mass) [13,[15][16][17]. The prevalence of CKD in genitourinary cancers were reported 8.7-21.4% [15,18].…”

Section: Discussionmentioning

confidence: 99%

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Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Hatakeyama

Kusaka

Hosogoe

et al. 2018

JCO

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Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost effectiveness after radical cystectomy.Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal-and high-risk patients, but the medical expense was high, especially in normal-risk (≤pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol.Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-and high-risk groups by a pathologybased protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared.Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.

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Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Hatakeyama

Kusaka

Hosogoe

et al. 2018

JCO

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“…121 In the United States alone, the health care costs for people with CKD requiring treatment for heart disease and other health problems made worse by their kidney disease exceeded $60 billion in 2007. The per-patient costs for dialysis in those participants who progress to ESRD are between $150,000 and $200,000 per year.…”

Section: Take-home Messagesmentioning

confidence: 99%

Mechanisms and Treatment of CKD

Ruggenenti

Cravedi

Remuzzi

2012

Journal of the American Society of Nephrology

233

183

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As CKD continues to increase worldwide, along with the demand for related lifesaving therapies, the financial burden of CKD will place an increasing drain on health care systems. Experimental studies showed that glomerular capillary hypertension and impaired sieving function with consequent protein overload play a pathogenic role in the progression of CKD. Consistently, human studies show that proteinuria is an independent predictor of progression and that its reduction is renoprotective. At comparable BP control, inhibitors of the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), more effectively than non-RAS inhibitor therapy reduce proteinuria, slow progression to ESRD, and even improve the kidney function achieving disease regression in some cases. In participants with diabetes, RAS inhibitors delay the onset of microalbuminuria and its progression to macroalbuminuria, and ACE inhibitors may reduce the excess cardiovascular mortality associated with diabetic renal disease. In addition to RAS inhibitors, however, multimodal approaches including lifestyle modifications and multidrug therapy will be required in most cases to optimize control of the several risk factors for CKD and related cardiovascular morbidity. Whether novel medications may help further improve the cost-effectiveness of renoprotective interventions is a matter of investigation.

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“…Recently, many studies have suggested that CKD is associated with poor prognosis, and independently predicts high mortality rates in cancer patients 6,7. CKD also is highly prevalent (incidence: 13.8%) in Korea.…”

Section: Introductionmentioning

confidence: 99%

Proteinuria as a Risk Factor for Mortality in Patients with Colorectal Cancer

et al. 2013

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PurposeWe investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths.Materials and MethodsWe retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage ≤3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced-stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m2). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death.ResultsThe number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality.ConclusionProteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.

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Chronic Kidney Disease in Cancer Patients: An Independent Predictor of Cancer-Specific Mortality

Cited by 89 publications

References 78 publications

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Mechanisms and Treatment of CKD

Proteinuria as a Risk Factor for Mortality in Patients with Colorectal Cancer

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