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- Title
Survival outcomes for patients with surgically induced end-stage renal disease.
- Authors
Bhindi, Bimal; Asante, Dennis; Branda, Megan E.; Hickson, LaTonya J.; Mason, Ross J.; Jeffery, Molly M.; Boorjian, Stephen A.; Leibovich, Bradley C.; Thompson, R. Houston
- Abstract
Introduction: While medically induced end-stage renal disease (m-ESRD) has been well-studied, outcomes in patients with surgically induced ESRD (s-ESRD) are unknown. We sought to quantitatively compare the non-oncological outcomes for s-ESRD and m-ESRD in a large, population-based cohort. Methods: Medicare patients >65 years old initiating hemodialysis were identified using the U.S. Renal Data System database (2000-2012). Metastatic cancer, prior transplant history, and nephrectomy for polycystic kidney disease were exclusion criteria. Patients were classified as having s-ESRD or m-ESRD based on hospital and physician claims for nephrectomy within a year preceding the onset of maintenance hemodialysis. Outcomes included non-cancer mortality (NCM), overall survival (OS), cardiovascular event (CVE), and renal transplantation. Time-to-event analyses were performed using Kaplan-Meier and cumulative incidence curves, and multivariable Cox and Fine-and-Crey regression models. Results: The cohort included 312 612 patients, of whom 1648 (0.53%) had s-ESRD. Compared to m-ESRD patients, s-ESRD patients had a significantly lower five-year cumulative incidence of NCM (68% vs. 80%; p<0.001) and CVE (62% vs. 68%; p<0.001), with a correspondingly higher probability of OS (22% vs. 17%; pcO.OOl) and rate of renal transplantation (3.6% vs. 2.0%; p<0.001). On multivariable analyses, s-ESRD remained associated with lower risks of NCM (p<0.001) and CVE (pcO.OOl), improved OS (pcO.001), and higher chance of renal transplantation (pcO.001). Conclusions: While outcomes for s-ESRD appear more favorable than m-ESRD, s-ESRD is still associated with a substantial risk of NCM and CVE, and a low incidence of renal transplantation in Medicare patients >65 years old. These non-oncological outcomes are worth considering in patients potentially facing postoperative ESRD.
- Subjects
CHRONIC kidney failure; POLYCYSTIC kidney disease; HEMODIALYSIS; DATABASES
- Publication
Canadian Urological Association Journal, 2020, Vol 14, Issue 3, pE65
- ISSN
1911-6470
- Publication type
Article
- DOI
10.5489/cuaj.6010