scholarly journals Cardiovascular outcomes in kidney cancer patients

2017 ◽  
Vol 10 (1_suppl) ◽  
pp. 24-28
Author(s):  
Elsie Ellimah Mensah ◽  
Luke Hounsome ◽  
Julia Verne ◽  
Roger Kockelbergh ◽  
Erik Mayer
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Significant Risk ◽  
Cancer Registration ◽  
Event Analysis ◽  
Co Morbidity ◽  
Renal Tumours

Introduction: In the surgical management of small renal tumours, current guidelines recommend that partial nephrectomy should be the preferred option wherever possible. This is based on evidence suggesting improved quality of life outcomes, morbidity and mortality and equivalent oncological outcomes when compared with radical nephrectomy. Chronic kidney disease is a significant risk factor for cardiovascular disease and subsequent mortality. This study explored differences in cardiac-related events and co-morbidity, using linked registry data for patients undergoing radical or partial nephrectomy for T1 renal tumours. Methods: Data from the National Cancer Registration Service was searched to identify T1 renal cancer diagnoses between 1999 and 2012. This data was matched against hospital episode statistics to identify those patients who had undergone radical or partial nephrectomy between 1999 and 2013 using OPCS codes. Data was collected on cardiac-related admissions and deaths in nephrectomy patients. Equivalent data was also collected for the general population to allow age-standardized comparison. Charlson score was used as a proxy for pre-operative co-morbidity. Results: Radical/partial nephrectomy patients had a greater risk of cardiac-related admissions compared with the general population (relative risk (RR) 3.32, 95% confidence interval (CI) 3.24–3.40), but with no increase in cardiac-related deaths (RR 0.84, 95% CI 0.70–1.01). There was no difference in the admission risk, or death, comparing radical or partial nephrectomy for T1 renal tumours (RR 1.02, 95% CI 0.88–1.17) using ‘time to event’ analysis. There was no difference in the comorbidity index between radical nephrectomy and partial nephrectomy patients. Conclusion: The higher incidence of cardiac-related admissions seen for radical/partial nephrectomy patients may be explained by a higher proportion of patients with medical illnesses including cardiovascular risk factors (hypertension, diabetes) undergoing renal imaging. The absence of a difference between the radical nephrectomy and partial nephrectomy groups supports the phenomenon of surgically-induced chronic kidney disease, which may not have the same morbidity implications as medically-induced chronic kidney disease.

scholarly journals Advancements in Laparoscopic Partial Nephrectomy: Expanding the Feasibility of Nephron-Sparing

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Eugene J. Pietzak ◽  
Thomas J. Guzzo
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Perioperative Complications ◽  
Oncologic Outcomes ◽  
Hemostatic Agents ◽  
Nephron Sparing

Partial nephrectomy (PN) offers equivalent oncologic outcomes to radical nephrectomy (RN) but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors.

scholarly journals Incidence of cardiovascular events and mortality in Korean patients with chronic kidney disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyunjin Ryu ◽  
◽  
Jayoun Kim ◽  
Eunjeong Kang ◽  
Yeji Hong ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Significant Risk ◽  
Asian Population ◽  
Incidence Rates ◽  
Composite Outcome ◽  
Total Cohort ◽  
Ckd Stage

AbstractFew studies have investigated the incidence of cardiovascular disease (CVD) in the Asian chronic kidney disease (CKD) population. This study assessed the incidence of CVD, death, and a composite outcome of CVD and death in a prospective Korean predialysis CKD cohort. From a total of 2179 patients, incidence rates were analyzed, and competing risk analyses were conducted according to CKD stage. Additionally, incidence was compared to the general population. During a median 4.1 years of follow-up, the incidence of CVD, all-cause death, and the composite outcome was 17.2, 9.6, and 24.5 per 1000 person-years, respectively. These values were higher in diabetic vs. non-diabetic subjects (P < 0.001). For all outcomes, incidence rates increased with increasing CKD stage (CVD, P = 0.001; death, P < 0.001; and composite, P < 0.001). Additionally, CKD stage G4 [hazard ratio (HR) 2.8, P = 0.008] and G5 (HR 5.0, P < 0.001) were significant risk factors for the composite outcome compared to stage G1 after adjustment. Compared to the general population, the total cohort population (stages G1–G5) showed significantly higher risk of CVD (HR 2.4, P < 0.001) and the composite outcome (HR 1.7, P < 0.001). The results clearly demonstrate that CKD is a risk factor for CVD in an Asian population.

scholarly journals A Systematically Collated Library of Prescribing Safety Indicators for People With Chronic Kidney Disease

2020 ◽  
Author(s):  
Fiona Smith ◽  
Samantha Hayward ◽  
Barnaby Hole ◽  
George Kimpton ◽  
Christine Sluman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Literature Search ◽  
Anatomical Therapeutic Chemical ◽  
Systematic Literature Search ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Quality Of Prescribing

Abstract BackgroundPeople with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. MethodsA systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. Results 9,852 papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%).Conclusion CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.

scholarly journals A systematically collated library of prescribing safety indicators for people with chronic kidney disease

2020 ◽  
Author(s):  
Fiona Smith ◽  
Samantha Hayward ◽  
Barnaby Hole ◽  
George Kimpton ◽  
Christine Sluman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Literature Search ◽  
Anatomical Therapeutic Chemical ◽  
Systematic Literature Search ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Quality Of Prescribing

Abstract BackgroundPeople with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. MethodsA systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. Results 9,852 papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%).Conclusion CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.

scholarly journals Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease

2013 ◽  
Vol 7 (3-4) ◽  
pp. 108-13 ◽  
Author(s):  
Zachary Klinghoffer ◽  
Jean-Eric Tarride ◽  
Giacomo Novara ◽  
Vincenzo Ficarra ◽  
Anil Kapoor ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Complication Rates ◽  
Small Renal Masses ◽  
Renal Masses

Objectives: To compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4 cm unilateral renal mass, a normal contralateral kidney and a normal pre-operative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25941 USD and generated 7.161 QALYs over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centers where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs.

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