Use of nephron-sparing surgery among renal cell carcinoma patients with diabetes and hypertension

Abstract

Objectives: Nephron-sparing surgery (NSS) is recommended for patients with renal cell carcinoma (RCC) at risk for chronic kidney disease (CKD). We assessed the prevalence of NSS among RCC patients with pre-existing diabetes or hypertension or both, who participated in a population-based epidemiologic RCC study.

Materials and methods: Patients with RCC were enrolled in the United States Kidney Cancer Study, a case-control study in the metropolitan areas of Detroit and Chicago from 2002 to 2007. After determining whether patients had diabetes or hypertension or both, we ascertained the proportion of patients from the Detroit site who received NSS. Bivariate and multivariate analyses were performed to evaluate associations between these CKD risk factors and receipt of NSS.

Results: We identified 835 patients treated with radical nephrectomy (78%) or NSS (22%) from 2002 to 2007. Among this cohort, 60% had pre-existing diabetes or hypertension or both. Patients with both diabetes and hypertension were more than twice as likely to receive NSS (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.47-3.96). Conversely, patients with only hypertension (OR 1.33, 95% CI 0.92-1.93) or diabetes (OR 0.97, 95% CI 0.92-1.93) were no more likely to receive NSS than patients with neither risk factor.

Conclusions: The more frequent utilization of NSS among patients with both diabetes and hypertension suggests growing recognition by urologists of the importance of these risk factors for future development of CKD among patients facing surgical therapy for RCC. However, the concurrent observation that patients with only one of these CKD risk factors did not receive increased utilization of NSS highlights an immediate opportunity to improve the surgical treatment of patients with RCC.

Keywords: Diabetes; Hypertension; Nephrectomy; Physician practice patterns; Renal cell carcinoma.

Figure 1. Use of NSS among patients with diabetes and/or hypertension

This figure demonstrates receipt of NSS based on pre-existing diabetes or hypertension. The y-axis shows the proportion who received NSS. The black bars represent patients with no prior diabetes or hypertension. The white bars present patients with diabetes only. The dark gray bars represent patients with hypertension only. Finally, the light gray bars represent patients with diabetes and hypertension. *p=0.02 for comparison of use of NSS between patients with diabetes and hypertension and those with no diabetes or hypertension. **There were no patients among this subgroup with diabetes only who received NSS.