Comparison of rates and risk factors for development of anaemia and erythropoiesis‐stimulating agent utilization after radical or partial nephrectomy

Abstract

0 9What ' s known on the subject? and What does the study add? The consequences and signifi cance of iatrogenically-induced CKD are poorly understood. Most data regarding risk of CKD and its complications are inferred from the medical literature. This is the fi rst study to examine impact of surgical management of renal masses on development of anaemia. Patients who underwent radical nephrectomy had a signifi cantly higher incidence of anaemia and ESA utilization than a contemporary well-matched cohort that underwent partial nephrectomy. The results obtained add to the growing body of data supporting the use of partial nephrectomy in the management of clinically appropriate renal masses. OBJECTIVE• To examine the incidence of and risk factors for the development of anaemia and erythropoiesis-stimulation agent (ESA) treatment in patients undergoing radical nephrectomy (RN) and partial nephrectomy (PN) because anaemia is a signifi cant cause of morbidity in chronic kidney disease. PATIENTS AND METHODS• The study comprised a retrospective review of 905 patients (610 RN/295 PN; mean age, 57.5 years; mean follow-up, 6.4 years) who underwent surgery for renal tumours at two institutions from July 1987 to June 2007.• Demographics, disease characteristics and pre-and postoperative (i.e. renal function, metabolic parameters, anaemia and ESA treatment) were recorded.• Data were analyzed within subgroups based on treatment (RN vs PN).• Multivariate analysis was conducted to determine the risk factors for developing anaemia after surgery. RESULTS• Tumour size (cm) was signifi cantly larger for RN (RN 7.0 vs PN 3.7; P < 0.001). No signifi cant differences were noted with respect to demographics and preoperative anaemia (RN 16.4% vs PN 18.6%; P = 0.454) and ESA-treatment (RN 0.7% vs PN 1.4%; P = 0.499).• After surgery, signifi cantly less de novo anaemia (PN 4.1% vs RN 17.5%; P < 0.001) and ESA utilization (PN 2.7% vs RN 13.4%; P < 0.001) occurred in the PN cohort.• Multivariate analysis showed that age ≥ 60 years (odds ratio, OR, 1.62; P = 0.008), African American ethnicity (OR, 2.30; P < 0.001), smoking (OR, 1.60; P = 0.013), glomerular fi ltration rate (GFR) < 60 mL/ min/1.73 m 2 (OR, 4.09; P < 0.001), ≥ 1 + proteinuria (OR, 2.19; P < 0.03), metabolic acidosis (OR, 4.08; P = 0.007) and RN (OR, 2.58; P < 0.001) were signifi cantly associated with de novo anaemia. CONCLUSIONS• Patients who underwent RN had a signifi cantly higher prevalence of anaemia and ESA-treatment compared to a well-matched cohort that underwent PN.• In addition to RN, age ≥ 60 years, African American ethnicity, history of smoking, GFR < 60 mL/min/1.73 m 2 , proteinuria and metabolic acidosis were associated with developing anaemia.

Does radical nephrectomy increase the risk of erectile dysfunction compared with partial nephrectomy? A cohort analysis

“…CKD is probably associated with multiple factors contributing towards ED, including but not limited to endothelial dysfunction [8], depression [10,21] and anaemia [22]. Surgical studies have demonstrated that RN increases the risk of CKD [12–14] and anaemia [18] compared with PN. These data support our results of increased de novo CKD and ED in the RN group.…”

“…CKD was calculated utilizing the modification of diet in renal disease equation [17]. Demographics and disease characteristics (age, race, body mass index [BMI], history of diabetes mellitus [DM], hypertension [HTN], hyperlipidaemia, anaemia [18], smoking history, tumour size, tumour stage, histology) and renal function parameters (eGFR, serum creatinine) were recorded. Tumour staging followed the 2002 American Joint Committee on Cancer TNM stage classification system [19].…”

Partial Nephrectomy for Renal Cell Carcinoma: Risk Factors for Acute Post-Operative Hemorrhage and Impact on Subsequent Hospital Course and Complete Nephrectomy Rate. An Analysis of 200 Consecutive Cases

“…That same study revealed that only 50% of tumors <2 cm were treated with partial nephrectomy, and 48% of tumors between 2 and 4 cm were treated with partial nephrectomy [12]. There is increasing evidence that surgically induced chronic kidney disease [13,14] following complete nephrectomy is associated with increased risk of cardiovascular disease including death [15,16] and metabolic adverse consequences including anemia, acidosis, and osteoporosis [17,18] and associated significant adverse health consequences.…”

Mid‐term UK outcomes data after extraperitoneal laparoscopic radical prostatectomy

“…a clinical T1a renal mass [5]. What we are missing from this analysis are longer term data, and a more thorough analysis of the incidence and impact of potential metabolic and cardiovascular sequelae during this period [4,6], and a comparative analysis that examines the timeline of renal functional recovery after partial nephrectomy. Because of these reasons, the reader should be cautioned not to over-interpret these findings, and to conclude that because RN is associated with renal functional recovery, performing a RN may not pose increased long-term risk compared with a nephron-sparing method, particularly in a patient with pre-existing medical drivers towards CKD (diabetes, obesity, hyperlipidaemia, etc.).…”

“…Of these, only 29 patients (5%) received postoperative radiotherapy. Evidence supports providing adjuvant radiotherapy to all men with adverse pathological features in the RP specimen [6,7]; however, this low rate of adjuvant radiotherapy could reflect individual patient or physician preference. …”