Senior Urologist Sahlgrenska University Hospital Gothenburg, Sweden
Background: End stage renal disease (ESRD) causes decreased quality of life for the patient and entails high treatment costs. Treatment of renal cell carcinoma (RCC) may increase the risk of ESRD.
Methods: Patients with RCC, identified in the National Swedish Kidney Cancer Register from 2005 to 2014 and 10 matched controls for each patient were linked to the Swedish Renal Registry and the National Patient Register. ESRD was defined as chronic kidney disease stage 5 (CKD5) or treatment with dialysis or renal transplantation 0-8 years after the diagnosis of RCC.
Results: 215 patients with RCC and subsequent ESRD were identified compared to 9299 patients with RCC only. The 10 year cumulative incidence of ESRD after RCC was 2.5 %. Hazard ratio for the relative risk compared to controls was 18 for the first year and 7 for year 1 to 10. In multivariable analyses significant (p < 0.05) risk factors for ESRD were male sex (Hazard Ratio 1.5 ,95% Confidence IntervaI 1.1-2.1), T2-4 vs T1 ( 1.4, 1.01-1.92), diabetes ( 1.9, 1.3-2.7), hypertension (1.9, 1.4-2.6) and CKD 1-4 ( 15.5, 8.6-27.9). Radical nephrectomy (RN) compared to partial nephrectomy (PN)/tumor ablation (TA) increased the risk of ESRD with a HR of 2.6 (1.3-5.2) within the first year after RCC diagnosis. Five-year overall survival was 29 % in RCC + ESRD patients and 64 % in patients with RCC only.
Conclusions: This population-based study showed that the incidence of ESRD after diagnosis of RCC was 2.5 % which was ten times higher than in the control population. RN compared to PN/TA was a significant risk factor during the first year. During 5 years after diagnosis male sex, advanced T-stage, diabetes, hypertension and CKD 1-4 were significant risk factors for ESRD.
