End-stage renal disease secondary to renal malignancy: Epidemiologic trends and survival outcomes

Objectives: Loss of renal parenchyma after surgery may contribute to chronic kidney disease; however, the long-term consequences of chronic kidney disease may differ by cause. We analyzed the outcomes of patients with end-stage renal disease (ESRD) based on various medical and surgical causes.

Materials and methods: In the United States Renal Data System from the period 1983 to 2007, patients with renal tumors, traumatic surgical loss, diabetes, or other known causes were identified. The annual incidence, prevalence, and influence of age, race, sex, and primary cause on survival were evaluated.

Results: Of 1.3 million patients, 6,812 (0.49%) had renal malignancy-related ESRD (RM-ESRD). An increased over time was noted in the standardized incidence rates of patients with RM-ESRD (R² = 0.973, P<0.0001). Patients with RM-ESRD had a worse median survival (1.9 vs. 3.4 y, P<0.0001), whereas those with ESRD related to nonmalignant surgical loss had improved survival (3.8 y) compared to diabetic ESRD (P<0.0001). The 5-year cancer-specific mortality was higher for RM-ESRD (30.9% vs. 5.5%, P<0.0001) compared to ESRD from other known causes; however, the non-cancer-specific mortality was improved compared to patients with ESRD with diabetic causes (P<0.0001). Limitations include retrospective analysis and lack of specific clinical data, such as cancer grade.

Conclusions: The incidence of RM-ESRD is increasing, possibly owing to the increased rate of renal cell carcinoma treatment. Although overall survival for RM-ESRD was worse than either that of nonmalignant surgical loss or other known causes, non-cancer-specific mortality was decreased compared to diabetic causes, likely due to systemic effects by cause of ESRD.