Cancer-Related End-Stage Renal Disease Incidence Increasing

From 1983 to 2007, the incidence of renal-malignancy end-stage renal disease (RM-ESRD) has greatly increased, according to the results of a study published recently in Urologic Oncology: Seminars and Original Investigations.

This increase may be due to an increased rate of diagnosis and treatment of renal malignancies, according to researcher Kevin A. Nguyen, MS, of the department of urology at Yale School of Medicine, New Haven, Connecticut, and colleagues.

The study compared epidemiologic trends and survival outcomes in patients with RM-ESRD compared with those with medical causes of ESRD. Data showed that overall survival was worse in RM-ESRD compared with ESRD from other factors, but that non–cancer-specific mortality was decreased compared with diabetic causes of ESRD.

“Overall, approximately 0.5% of patients with renal cell carcinoma will develop ESRD that is thought to be primarily due to cancer treatment,” Nguyen and colleagues wrote. “Patients with RM-ESRD and diabetic ESRD experience the worst overall survival outcomes despite controlling for age, race, and sex. Although cancer death may be responsible for worse overall survival in patients with RM-ESRD, the improved non–cancer-specific mortality suggests that those who do not die from cancer may have improved overall health outcomes when compared to systemic causes of ESRD.”

Researchers identified 1.3 million patients from the United States Renal Data System from 1983 to 2007. Patients could have ESRD from renal tumors, trauma surgical loss, diabetes, or other causes. Of the 1.3 million patients, 0.49% had RM-ESRD. The number of patients with RM-ESRD increased over time (P < .0001).

“Although the information provided on cancer treatment was limited, it is reasonable to assume that surgical management is a major contributor to nephron loss, as medical causes of chronic kidney disease such as toxicity from chemotherapy or malignant obstruction are rare in kidney cancer,” the researchers wrote. “The long-term consequences of receiving kidney cancer treatment are also implicated to be partially responsible for the observed increased incidence of RM-ESRD.”

Those patients with RM-ESRD had a worse median survival compared to those with non–malignancy related ESRD (1.9 years vs 3.4 years; P < .0001). Those patients with non-malignancy surgical loss ESRD had improved survival compared with patients with diabetes-related ESRD (P < .001).

“We demonstrate that patients with RM-ESRD have worse survival outcomes that are attributed to cancer progression as patients with RM-ESRD have a greater than threefold cancer mortality compared to patients with other causes of ESRD,” the researchers wrote. “Although we do not have access to tumor characteristics, the significant mortality suggests that these cancers are likely larger tumors with more aggressive biologic potential.”

In addition, the 5-year cancer-specific mortality was significantly higher for patients with RM-ESRD (30.9% vs 5.5%; P < .0001) compared with non-malignancy ESRD. However, the non–cancer-specific mortality was significantly better in patients with RM-ESRD compared with those with diabetes-related ESRD (P < .0001).