Predictors of new‐onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population‐based analysis

Ahn, Thomas; Ellis, Robert J.; White, Victoria; Bolton, Damien; Coory, Michael; Davis, Ian D.; Francis, Ross; Giles, Graham G.; Gobé, Glenda C.; Hawley, Carmel; Johnson, David W.; Marco, David; McStea, Megan; Pascoe, Elaine M.; Wood, Simon; Jordan, Susan J.; Investigators, I. Ckd

doi:10.1002/jso.25037

Cited by 15 publications

(30 citation statements)

References 42 publications

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“…These variables have previously been shown to be strongly associated with risk of CKD after nephrectomy. 11,17 The score reliably categorised risk of clinically significant CKD.…”

Section: Discussionmentioning

confidence: 99%

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A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation

Ellis

Vecchio

Aliano

et al. 2020

JASN

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BackgroundClinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed.MethodsTo develop a tool for stratifying patients’ risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012–2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors—age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)—to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk).ResultsAbsolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts.ConclusionsOur simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool’s quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.

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“…These variables have previously been shown to be strongly associated with risk of CKD after nephrectomy. 11,17 The score reliably categorised risk of clinically significant CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Data collection was retrospective and described previously. 11 Validation cohort 2 was a prospectively recruited convenience sample of 179 patients managed for kidney tumours between June 2013 and January 2018 at a single tertiary hospital (Princess Alexandra Hospital) in Brisbane, Australia. Data collection was described previously.…”

Section: Study Populationmentioning

confidence: 99%

A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation

Ellis

Vecchio

Aliano

et al. 2020

JASN

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“…Reported factors that may influence PN use include patient characteristics such as younger age, less comorbidities, less complex tumour characteristics graded with scoring systems (e.g. RENAL nephrometry scoring system) and management factors such as high surgeon and/or hospital volume, urban and academic centre settings . Specifically in Australia, Patel et al .…”

Section: Discussionmentioning

confidence: 99%

“…24 The near fivefold increase in the use of PN observed here was similar to that observed in a sixcentre study across Italy and France, where a 4.5-fold increase in PN use was observed between 1987 and 2007. 23 Reported factors that may influence PN use include patient characteristics such as younger age, 10,25,26 less comorbidities, 11,25 less complex tumour characteristics graded with scoring systems (e.g. RENAL nephrometry scoring system) 27 and management factors such as high surgeon and/or hospital volume, urban and academic centre settings.…”

Section: Discussionmentioning

confidence: 99%

“…RENAL nephrometry scoring system) 27 and management factors such as high surgeon and/or hospital volume, urban and academic centre settings. 10,11,20,26 Specifically in Australia, Patel et al 10 found an increased likelihood of patients undergoing PN between 2001 and 2009 if treated in a private New South Wales hospital with suggestion related to increased experience of the operating consultant compared to a registrar in the public system. However, this discrepancy was not reported in a Victorian study between 2009 and 2013.…”

Section: Discussionmentioning

confidence: 99%

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Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data

Ali

Ahn

Papa

et al. 2019

ANZ Journal of Surgery

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Background Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic‐assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. Methods Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population‐adjusted rate and renal cancer‐adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. Results Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87–4.16, RN: 6.52–6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer‐adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%–41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). Conclusions Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.

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Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma

Ellis

White

Coory

et al. 2019

Clinical Genitourinary Cancer

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MicroAbstract Chronic kidney disease (CKD) following radical nephrectomy is common, and associated with an increased risk of morbidity and mortality. This study utilised population-based samples from the Australian states of Queensland and Victoria to identify factors which were associated with a higher likelihood of developing CKD. Apart from recognised CKD risk factors, rural place of residence, and being managed in private compared with public hospitals was associated with higher odds of CKD.

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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

Cited by 15 publications

References 42 publications

A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation

A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation

Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data

Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma

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