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      Increased Risk of End-Stage Renal Disease in Patients with Renal Cell Carcinoma: A 12-Year Nationwide Follow-Up Study

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      Author(s): , MD, , MD, , MD, PhD, , MPH, , MD, , MD, , PhD
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      Publication date (Electronic):
      Journal: Medicine
      Publisher: Wolters Kluwer Health

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          Abstract

          The effect of renal cell carcinoma (RCC) on the risk for end-stage renal disease (ESRD) has not been confirmed. The present population-based study used the claims data from the Taiwan National Health Institutes from 1998 to 2010 to compare the risk for ESRD in patients with and without RCC.

          The study cohort consisted of 2940 patients who had newly diagnosed with RCC but no history of ESRD; the control cohort consisted of 23,520 matched patients without RCC. Cox proportional hazard regressions were performed to compute ESRD risk after adjusting for possible confounding factors. Kaplan–Meier analysis and the log-rank test were also used to compare patients and controls.

          A total of 119 patients in the RCC group (incidence rate: 119/2940; 4.05%) and 160 patients in the control group (incidence rate: 160/23,520; 0.68%) were diagnosed with ESRD during the follow-up period. After adjusting for potential confounders, the RCC group had an ESRD hazard ratio (HR) of 5.63 [95% confidence interval (CI): 4.37–7.24] relative to the control group. In addition, among patients with RCC, females (adjusted HR: 6.95, 95% CI: 4.82–10.1) had a higher risk for ESRD than males (adjusted HR: 4.79, 95% CI: 3.37–6.82). Finally, there were significant joint effects of chronic kidney disease and diabetes on increasing the risk of ESRD in patients with and without RCC ( P < 0.01). The limitations of this study include the retrospective design and the inability to assess methods of treatment and measure the aggressiveness of RCC.

          Our data indicates that RCC is an independent risk factor for ESRD, especially in females.

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          Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study.

          William C Huang, Andrew Levey, Angel Serio … (2006)
          Chronic kidney disease is a graded and independent risk factor for substantial comorbidity and death. We aimed to examine new onset of chronic kidney disease in patients with small, renal cortical tumours undergoing radical or partial nephrectomy. We did a retrospective cohort study of 662 patients with a normal concentration of serum creatinine and two healthy kidneys undergoing elective partial or radical nephrectomy for a solitary, renal cortical tumour (
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            Cancer in patients on dialysis for end-stage renal disease: an international collaborative study.

            G Buccianti, A Lowenfels, L Agodoa … (1999)
            Previous studies have suggested that the frequency of cancer is higher in patients with end-stage renal disease (ESRD) than in the general population, but have not established whether this increase is confined to certain cancers or to certain categories of ESRD patients. The aim of this study was to examine the risk of cancer in a large cohort of patients treated by dialysis but not transplantation. We assembled a cohort of 831,804 patients who received dialysis during the period 1980-94 for ESRD in the USA, Europe, Australia, or New Zealand. We compared the observed frequency of cancer among these patients during 2,045,035 person-years of follow-up with the frequency of cancer in the respective background populations. During average follow-up of 2.5 years, 25,044 (3%) of 831,804 patients developed cancer compared with an expected number of 21,185 (standardised incidence ratio 1.18 [95% CI 1.17-1.20]). We observed a higher risk of cancer in patients younger than 35 years (3.68 [3.39-3.99]), and the risk gradually decreased with increasing age. High risks were observed for cancer of the kidney (3.60 [3.45-3.76]), bladder (1.50 [1.42-1.57]), and thyroid and other endocrine organs (2.28 [2.03-2.54]). Excess cancers appeared in several organs for which viruses have been suspected as causative agents, whereas cancers of the lung, colorectum, prostate, breast, and stomach were not consistently increased. The overall risk of cancer is increased in patients with ESRD, and the distribution of tumour types resembles the pattern seen after transplantation (although we have no data to make the comparison with skin cancer). The excess risk can largely be ascribed to effects of underlying renal or urinary-tract disease, or of loss of renal function, on the kidney and bladder, and to increased susceptibility to viral carcinogenesis. The relative risk, which is especially high in younger patients, gradually diminishes with age.
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              Epidemiological features of CKD in Taiwan.

              Hsin-Wei Kuo, Shang-Shyue Tsai, Mao-Meng Tiao … (2007)
              The incidence of end-stage renal disease (ESRD) in Taiwan is the highest in the world. However, epidemiological features of earlier chronic kidney disease (CKD) have not been investigated. Since implementation of the National Health Insurance Program in 1995, more than 96% of the population in Taiwan has been enrolled. A nationally representative cohort of 200,000 individuals randomly sampled from the National Health Insurance enrollees was followed up from 1996 to 2003. Clinical conditions were defined by using diagnostic codes. The prevalence and incidence of clinically recognized CKD were assessed. We also identified risk factors associated with the development of CKD. The prevalence of clinically recognized CKD increased from 1.99% in 1996 to 9.83% in 2003. The overall incidence rate during 1997 to 2003 was 1.35/100 person-years. The multivariate model indicates that age is a key predictor of CKD, with an odds ratio of 13.95 for the group aged 75-plus years compared with the group younger than 20 years. Other factors associated with increased risk for the development of CKD include diabetes, hypertension, hyperlipidemia, and female sex. The prevalence and incidence of CKD in Taiwan are relatively high compared with other countries. Our finding provides a reasonable explanation for the subsequent epidemic of ESRD in Taiwan. Further study is needed to identify the entire burden of CKD and the effectiveness of risk-factor modification.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: August 2014
                Publication date (Electronic): 04 August 2014
                Volume: 93
                Issue: 8
                Electronic Location Identifier: e52
                Affiliations
                Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-yi, and Department of Applied Life Science and Health (P-HH), Chia-Nan University of Pharmacy and Science, Tainan; Department of Tramatology (H-BT); Department of Internal Medicine (K-YH), National Taiwan University Hospital, Taipei; Department of Medicine (C-HM, C-HC), College of Medicine, China Medical University; Management Office for Health Data (C-HM), China Medical University and Hospital; Division of Nephrology (M-CC), Department of Medicine, Taichung Veterans General Hospital; Department of Urology (C-HC), China Medical University and Hospital; and Department of Health Risk Management, College of Public Health, China Medical University, and Department of Medical Research (C-JC), China Medical University Hospital, Taichung, Taiwan.
                Author notes
                Correspondence: Chi-Jung Chung, PhD, Department of Health Risk Management, China Medical University, No. 91 Hsueh-Shih Road, Taichung 404, Taiwan (e-mail: cjchung@ 123456mail.cmu.edu.tw ).
                Article
                Accession ID: 00052
                DOI: 10.1097/MD.0000000000000052
                PMC ID: 4602444
                PubMed ID: 25121356
                SO-VID: bddb1366-2631-407d-90a4-20ec8ab30b6f
                Copyright © © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
                License:

                This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                Date received : 9 April 2014
                Date revision received : 12 June 2014
                Date accepted : 17 June 2014
                Categories
                Subject: Article
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