Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline

2017 ◽  
Vol 35 (6) ◽  
pp. 668-680 ◽  
Author(s):  
Antonio Finelli ◽  
Nofisat Ismaila ◽  
Bill Bro ◽  
Jeremy Durack ◽  
Scott Eggener ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Management Options ◽  
Small Renal Masses ◽  
Eligibility Criteria ◽  
Renal Masses ◽  
American Society ◽  
Meta Analyses

Purpose To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.

Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney Disease

Urology ◽  
2012 ◽  
Vol 80 (4) ◽  
pp. 845-851 ◽  
Author(s):  
Julien Guillotreau ◽  
Rachid Yakoubi ◽  
Jean-Alexandre Long ◽  
Joseph Klink ◽  
Riccardo Autorino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

The economic and clinical costs of chronic kidney disease following radical and partial nephrectomy in the management of small renal masses.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 353-353
Author(s):  
S. L. Chang ◽  
L. E. Cipriano ◽  
L. C. Harshman ◽  
B. I. Chung
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
Partial Nephrectomy ◽  
Base Case ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Impact

353 Background: Postoperative chronic kidney disease (PCKD), defined as a glomerular filtration rate of < 60mL/min/1.73m2, is a recognized adverse outcome after extirpative therapy for small renal masses (SRM, ≤ 4cm). We quantified the long-term economic and clinical costs of PCKD following radical and partial nephrectomy for the management of SRM. Methods: Using a Markov model, we evaluated open and laparoscopic approaches for radical and partial nephrectomy in the treatment of SRMs. The base case was a 65-year old healthy individual with a unilateral SRM and normal renal function. We used a 3-month cycle length, lifetime horizon, societal perspective, and 3% discount rate. The costs, quality of life adjustments, and transition probabilities were estimated from the literature, Medicare, and expert opinion. Health outcomes were measured in quality-adjusted life-years (QALY) gained and costs in 2008 U.S. dollars. The model was tested with sensitivity analyses. Results: The average discounted lifetime outcomes are listed in the Table. There were minimal differences between the open and laparoscopic approaches. PCKD led to a substantial increase costs and decrease in health outcomes. The impact of PCKD was indirectly associated with age. Conclusions: Partial nephrectomy provides cost-savings and improved health outcomes compared to radical nephrectomy in the management of patients with SRMs. Both procedures incur significant economic and clinical costs due to the development of PCKD. A discussion about the potential for PCKD should be incorporated into the informed consent for surgical treatment of SRMs. [Table: see text] No significant financial relationships to disclose.

1111 ROBOTIC PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
julien guillotreau ◽  
rachid yakoubi ◽  
joseph klink ◽  
riccardo autorino ◽  
jean alexandre Long ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Efficacy and Safety of ACEIs/ARBs in Patients with COVID-19 Combined with Chronic Kidney Disease: a Protocol for Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Jing Xie ◽  
Xueying Li ◽  
Nan Mao ◽  
Sichong Ren ◽  
junming Fan
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systematic Reviews ◽  
Control Measure ◽  
Angiotensin Receptor Blockers ◽  
Grey Literature ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Converting Enzyme Inhibitors ◽  
Meta Analyses

Abstract Background: Despite the control measure taken against the coronavirus disease 2019(COVID-19) at global level, the pandemic has started to rebound and transmitted rapidly worldwide due to the delta strain. This strain is more virulent than the original severe acute respiratory syndrome coronavirus 2 virus. The approved vaccines or drugs can reduce mortality; still various efforts are being made to seek a complete cure. Currently, it remains controversial whether angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are useful in managing COVID-19 patients having comorbidities like chronic kidney disease(CKD). Evidence concerning the application of ACEIs/ARBs needs to be established through advanced meta-analyses and systematic reviews.Methods/design:This study is designed following the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses). The studies published from December 1, 2019, to August 31, 2021 will be considered. The primary databases such as Cochrane Library, MEDLINE, EMBASE, and Chinese Biomedical Literature Database will be included, and meeting records and grey literature databases will be retrieved to compare at least two terminations or discontinued ACEIs or ARBs in clinical intervention studies. The primary results will include kidney function biomarkers, blood pressure, and long-term mortality or hospital admission severity. Pairwise random effects and meta-analyses will be performed for the selected literature using RevMan (V.5.3). The bias risk evaluation, heterogeneity, consistency, transitivity, and evidence quality will be followed as described in the Cochrane Handbook for Systematic Reviews of Interventions suggestions.Discussion: This review will use a structured and effective method to analyze the effectiveness and security of ACEIs and ARBs in treating COVID-19 patients with CKD. Research results can present valuable evidence for patients, clinicians, researchers, or decision-makers.Systerm review: PROSPERO registration number CRD42021268701.

Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline

2017 ◽  
Vol 35 (8) ◽  
pp. 893-911 ◽  
Author(s):  
Saro H. Armenian ◽  
Christina Lacchetti ◽  
Ana Barac ◽  
Joseph Carver ◽  
Louis S. Constine ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Cardiac Dysfunction ◽  
Randomized Clinical Trials ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Routine Surveillance ◽  
Screening Strategies ◽  
Cardiac Evaluation ◽  
American Society ◽  
Meta Analyses

Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

scholarly journals The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: Protocol for a Systematic Review.

2020 ◽  
Author(s):  
Andreas Kousios ◽  
Alexandros Hadjivasilis ◽  
Panayiotis Kouis ◽  
Andrie Panayiotou
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Cochrane Collaboration ◽  
Renal Outcomes ◽  
Short And Long Term ◽  
The Cochrane Collaboration

Abstract Background/Objectives: Fibrates reduce cardiovascular risk in the general population and in patients with chronic kidney disease (CKD). Although, they are commonly used as second-line agents in addition to statins for hypertriglyceridemia, their use in CKD is limited due to a decrease of glomerular filtration rate (GFR) at treatment initiation. This change in GFR is reversible with fibrate discontinuation. Importantly, randomised control trials with fibrate treatment have demonstrated reduction in proteinuria and benefit for microvascular diabetic complications. In addition, a number of experimental studies have shown nephroprotective effects with fibrates through attenuation of renal fibrosis and inflammation. Thus, the effect of fibrates on renal outcomes remains undetermined. The objective of this systematic review is to summarize the evidence from randomised controlled studies and provide pooled estimates on the effect of fibrates on short- and long-term renal outcomes. Methods/Design: The study will be contacted according to the Cochrane Collaboration principles for Systematic reviews. We will include randomised trials comparing fibrate to placebo or studies comparing the addition of fibrate on statin versus statin alone and reporting on the short- and long-term effects on renal function, CKD progression and proteinuria. We will examine studies including patients with established CKD and those studies including patients at risk of developing CKD, separately. A comprehensive summary of the evidence will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data from included studies suitable for metanalysis will be analyses accordingly to provide quantitative estimates using a random effects model. The Cochrane Collaboration tool for assessing the risk of bias in randomized clinical trials will be utilised. The quality of the evidence from included studies will be addressed descriptively using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).Discussion: The results of this systematic review will be informative for clinicians. A summary of high-level evidence with robust estimates of the effect of fibrates on safety and renal outcomes may be used to inform clinical practice guideline development for dyslipidaemias and primary and secondary prevention of CVD. Systematic review registration: PROSPERO CRD42020187764

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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