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Kennedy C, Bargman JM. Noninfectious Complications of Peritoneal Dialysis. NOLPH AND GOKAL'S TEXTBOOK OF PERITONEAL DIALYSIS 2023:467-509. [DOI: 10.1007/978-3-030-62087-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Pyrża M, Głogowski T, Wieliczko M, Żebrowski P, Ewa W, Semeniuk-Wojtaś A, Stec R, Nazarewski S, Małyszko J. Malignancy Prevalence in the Dialyzed Population and in Waitlisted Potential Kidney Transplant Recipients. Transplant Proc 2022; 54:930-933. [DOI: 10.1016/j.transproceed.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
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Xiaohong C, Jianzhou Z, Bo S, Wenlv L, Xuesen C, Fangfang X. Differences between exhausted CD8 + T cells in hepatocellular carcinoma patients with and without uremia. Can J Physiol Pharmacol 2021; 99:395-401. [PMID: 32799654 DOI: 10.1139/cjpp-2019-0641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of this study was to explore the differences between exhausted CD8+ T cells in hepatocellular carcinoma (HCC) patients with and without uremia. We enrolled 45 uremic patients who were recently diagnosed with HCC into the HCC + uremia cohort and similar patients with HCC but without uremia into the HCC-only cohort. Lymphocytes were obtained from the two cohorts, and exhausted CD8+ T cells, comprising PD-1+CD8+, TIM-3+CD8+, and LAG-3+CD8+ T cells, were sorted and expanded in vitro. After expansion, the proportions of PD-1+CD8+, TIM-3+CD8+, and LAG-3+CD8+ T cells were significantly higher in the HCC-only cohort than in the HCC + uremia cohort. CD8+ T cells expressing PD-1, TIM-3, or LAG-3 showed increased tumor reactivity and release of interferon-γ in vitro; however, these cells demonstrated weaker anti-tumor activity in HCC + uremia patients than in HCC-only patients. Among the expanded lymphocytes, only the decreased proportion of PD-1+CD8+ T cells significantly correlated with the HCC + uremia cohort (odds ratio of 2.731, p = 0.009). We concluded that peripheral CD8+ T cells expressing PD-1, TIM-3, or LAG-3 from the HCC + uremia cohort were dysfunctional in vitro. Among these populations, PD-1+CD8+ T cells were most evident in HCC patients with uremia.
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Affiliation(s)
- Chen Xiaohong
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Zou Jianzhou
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Shen Bo
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Lv Wenlv
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Cao Xuesen
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Xiang Fangfang
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
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Long-Term Outcomes of Pulmonary Resection for Lung Cancer Patients with Chronic Kidney Disease. World J Surg 2020; 43:3249-3258. [PMID: 31485810 DOI: 10.1007/s00268-019-05143-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The survival outcome in lung cancer patients with chronic kidney disease (CKD) has not been well evaluated. The aim of this study was to evaluate the survival outcomes following non-small cell lung cancer (NSCLC) surgery in patients with CKD as a preoperative comorbidity. METHODS Among 671 patients who underwent surgery for NSCLC between 2007 and 2014 at our hospital, 55 (8%) had CKD and we retrospectively analyzed the survival outcomes of these patients. RESULTS Most patients with CKD were elderly and male. Patients with CKD had a higher frequency of smoking habit, cardiovascular disease, and pulmonary diseases, and a notably lower pulmonary function, resulting in receiving limited pulmonary resection. There were no marked differences in the frequency of surgical complications between patients with and without CKD (p = 0.16). Squamous cell carcinoma was more frequently diagnosed in patients with CKD than in those without it. The 5-year disease-free survival rates in patients with and without CKD were 60.0% and 69.7% (p = 0.06), respectively, and the 5-year overall survival rates were 68.9% and 80.0%, respectively, showing significant differences (p = 0.01). The rate of receiving supportive care was higher in patients with CKD when recurrence observed. CONCLUSION CKD is associated with a poorer overall survival in patients who undergo lung cancer resection for recurrent disease. As patients with CKD tend to have a poor respiratory function, thoracic surgeons should carefully select the resection type to balance the therapeutic benefit and invasiveness.
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Akand M, Muilwijk T, Van Der Aa F, Gevaert T, Milenkovic U, Moris L, Blyweert W, Van Poppel H, Albersen M, Joniau S. Prognostic score predicts overall survival following complete urinary tract extirpation. Scand J Urol 2020; 54:70-79. [PMID: 31975650 DOI: 10.1080/21681805.2020.1716069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To evaluate the oncological outcome and complications of patients treated with complete urinary tract extirpation (CUTE) in our department, and to identify prognostic factors for survival.Methods: Clinico-pathological data of patients treated with one-step or stepwise CUTE between 1999 and 2017 were collected retrospectively. Complications were classified according to the modified Clavien-Dindo classification (CDC) in the early (≤30 days) and late (>30 days) follow-up. Log-rank test was used to assess independent predictors of overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS).Results: Twenty-five patients (20 male) underwent CUTE (16 one-step) for BC + unilateral/bilateral UTUC. Minor (CDC 1-2) and major (CDC3-5) complications were observed in 72% and 40% of patients, respectively, in the early postoperative period (≤30 days). Five (20%) patients died in the perioperative period (CDC 5) with a median OS of 52 days (range: 25-77). Median time to last follow-up or death was 30 months (range: 0-161). Median OS was 50 months (95% Confidence Interval [CI]: 22-118 months), while median CCS and RFS were not reached. The 5-year OS, CSS and RFS were 42.7%, 69.6% and 66.7%, respectively. A score for determining which patients would benefit from CUTE was arbitrarily developed, and showed that the patients with a score of 0-2 points (good prognosis) had a better OS than the patients with a poor prognosis (3-4 points) in the log-rank test.Conclusions: Because of lower OS rates, patients with ESRD or with a CUTE score of 3-4 points are probably not ideal candidates for CUTE.
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Affiliation(s)
- Murat Akand
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Gevaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Blyweert
- Urology Department, ZorgSaam Ziekenhuis, Terneuzen, The Netherlands
| | | | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Lin X, Goyal R, Yang XJ. Pathologic characterization of renal epithelial neoplasms arising in nonfunctioning kidneys. Hum Pathol 2019; 97:1-7. [PMID: 31857138 DOI: 10.1016/j.humpath.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/18/2022]
Abstract
Nonfunctioning kidneys secondary to various etiologies display different histopathological features. Studies focused on incidence and types of renal neoplasms using the new World Health Organization and International Society of Urological Pathology classification system in various types of nonfunctioning kidneys are very limited. We identified 311 nephrectomies of nonfunctioning kidneys and categorized them into 5 categories: acquired cystic kidney disease (ACKD, n = 61); end-stage renal disease, nonspecific (ESRD, n = 63); adult polycystic kidney disease (APKD, n = 49); failed transplant kidney (FTK, n = 96); and those caused by obstructive conditions in the kidney (OCK, n = 42). ACKD (70%) and ESRD (43%) had higher cancer incidences than the other 3 groups (APKD = 2%, FTK = 0%, and OCK = 5%). Besides clear cell renal cell carcinoma (RCC) and papillary RCC, clear cell papillary RCC had a much higher incidence within ACKD patients (13/61) compared to other groups. ACKD-associated RCC was only identified in ACKD patients. ACKD patients had significantly longer dialysis duration compared to ESRD, APKD, and FTK. Although they had similar risk for clear cell RCC and papillary RCC, ACKD patients had a much higher risk for ACKD-associated RCC and clear cell papillary RCC than ESRD patients. Although most RCCs arising in these nonfunctioning kidneys were early pT1 stage, 6 ACKD patients and 3 ESRD patients had higher-stage diseases, which can be fatal if not treated appropriately. Therefore, precise clinicopathological classification of these nonfunctioning kidneys is important for predicting kidney cancer risk. These results indicate the need for active monitoring of the patients with high-risk nonfunctioning kidney diseases and appropriate surgical treatment when necessary.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Renal Cell/epidemiology
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/physiopathology
- Carcinoma, Renal Cell/surgery
- Female
- Humans
- Incidence
- Kidney Diseases, Cystic/epidemiology
- Kidney Diseases, Cystic/pathology
- Kidney Diseases, Cystic/physiopathology
- Kidney Diseases, Cystic/therapy
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/pathology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/therapy
- Kidney Neoplasms/epidemiology
- Kidney Neoplasms/pathology
- Kidney Neoplasms/physiopathology
- Kidney Neoplasms/surgery
- Kidney Transplantation
- Male
- Middle Aged
- Nephrectomy
- Polycystic Kidney Diseases/epidemiology
- Polycystic Kidney Diseases/pathology
- Polycystic Kidney Diseases/physiopathology
- Polycystic Kidney Diseases/therapy
- Prognosis
- Renal Dialysis
- Risk Assessment
- Risk Factors
- Treatment Failure
- Young Adult
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Affiliation(s)
- Xiaoqi Lin
- Department of Pathology, Northwestern University, Chicago, IL 60611
| | - Rajen Goyal
- Department of Pathology, Northwestern University, Chicago, IL 60611
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Chicago, IL 60611.
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García Agudo R, Aoufi Rabih S, González Carro P, Pérez Roldán F, Proy Vega B, Arias Arias Á, Cazalla Cadenas F, Tenías Burillo JM, Fernández Rodríguez A. Gastrointestinal lesions in chronic kidney disease patients with anaemia. Nefrologia 2018; 39:50-57. [PMID: 30153940 DOI: 10.1016/j.nefro.2018.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/15/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the frequency with which anaemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. METHOD A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1-5 and anaemia who had a positive qualitative immunochemical faecal occult blood test. RESULTS A total of 9,658 patients with CKD were analysed, of which 286 (2.9%) had anaemia; 198 had a positive faecal occult blood test (47% male, 71.1±11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischaemic colitis (3.1%). Uraemia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anaemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anaemia were risk factors for adenomatous polyps and colorectal cancer. CONCLUSION Renal patients with anaemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3-5.
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Affiliation(s)
- Rebeca García Agudo
- Servicio de Nefrología, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España; Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España.
| | - Sami Aoufi Rabih
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España; Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Pedro González Carro
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Francisco Pérez Roldán
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Beatriz Proy Vega
- Servicio de Farmacia Hospitalaria, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Ángel Arias Arias
- Unidad de Apoyo a la Investigación, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Fátima Cazalla Cadenas
- Servicio de Nefrología, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - José María Tenías Burillo
- Unidad de Apoyo a la Investigación, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Ana Fernández Rodríguez
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
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Acceleration of carboxylesterase-mediated activation of irinotecan to SN-38 by serum from patients with end-stage kidney disease. Cancer Chemother Pharmacol 2018; 81:1121-1128. [PMID: 29693202 DOI: 10.1007/s00280-018-3583-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Pharmacokinetics and pharmacodynamics of irinotecan have been reported to be altered in cancer patients with end-stage kidney disease (ESKD). Carboxylesterase (CES) has an important role in metabolism of irinotecan to its active metabolite, SN-38, in human liver. The purpose of the present study was to investigate whether CES activity was altered in ESKD patients. METHODS The present study investigated the effects of uremic serum, uremic toxins, and fatty acids on the hydrolysis of irinotecan and a typical CES substrate, p-nitrophenyl acetate (PNPA), in human liver microsomes. Normal and uremic serum samples were deproteinized by treatment with methanol were used in the present study. RESULTS The present study showed that both normal and uremic serum significantly inhibited CES-mediated metabolism of both irinotecan and PNPA. The inhibition by uremic serum was weaker than that by normal serum, suggesting that CES activity may be higher in ESKD patients. Although four uremic toxins did not affect PNPA metabolism, arachidonic acid inhibited it. There was no difference in inhibitory effect of PNPA metabolism between both mixtures of seven fatty acids used at concentrations equivalent to those present in 10% normal or uremic serum. Interestingly, those mixtures had a more pronounced effect than either 10% normal or uremic serum. CONCLUSIONS The present study showed that the inhibition of CES activity by uremic serum was weaker than that by normal serum, suggesting that an increase in maximum plasma concentration of SN-38 in cancer patients with ESKD can be attributed to an accelerated CES-mediated irinotecan hydrolysis.
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Gornik H, Lazarus J, Chertow G. Cancer Screening and Detection in Patients with End-Stage Renal Disease. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- H.L. Gornik
- Renal Division Harvard Medical School, Boston, MA
| | - J.M. Lazarus
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - G.M. Chertow
- Fresenius Medical Care North America, Lexington, MA
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A proof-of-concept study analyzing the clinical utility of fluorine-18-sodium fluoride PET-CT in skeletal staging of oncology patients with end-stage renal disease on dialysis. Nucl Med Commun 2017; 38:1067-1075. [PMID: 28953207 DOI: 10.1097/mnm.0000000000000759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE The quality of conventional bone scintigraphy can be poor in patients with end-stage renal disease (ESRD). Fluorine-18-sodium fluoride (F-NaF) PET-computed tomography (CT) has rapid single-pass extraction, fast clearance from the soft tissues and a better target to background ratio. The aim of the present study is to preliminarily assess the superior tracer kinetics of F-NaF in ESRD patients. MATERIALS AND METHODS A cohort comprising of 13 patients with ESRD (mean age 65.5 years; median age 68.5 years; six men and seven women) and a control group of 20 patients with normal renal function (mean age 64±7.7 years, nine men and 11 women) were analyzed qualitatively and quantitatively. Both sets of patients were referred for osseous staging of malignancy. All patients underwent a PET-CT scan after an injection of 0.06 mCi/kg of F-NaF. RESULTS Qualitative analysis of the ESRD and the control group did not show a significant difference. The signal to noise ratio in the ESRD group (26.24±10.5) and the control group was similar (22.06±10.9), P=0.35. The extraction of radiotracer in bone was higher in ESRD with a bone to soft tissue index of 4.03±2.2 versus 2.48±1.0 in control patients (P=0.01). F-NaF PET-CT was positive for bone metastases in three patients and negative in 10 patients. Of the 48 total lesions, 34 (71%) were classified as benign on F-NaF PET-CT, whereas 10 (21%) were classified as malignant and four (8%) were classified as equivocal. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-NaF PET-CT were 91, 89.5, 90, 71.4, and 89.7%, respectively (P<0.001). CONCLUSION The image quality of F-NaF PET-CT in patients with ESRD was comparable to imaging in patients with normal renal function. This can potentially translate into better diagnostic performance in patients with ESRD.
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Long-term outcomes of complete urinary tract exenteration for dialysis patients with urothelial cancer. Int Urol Nephrol 2017; 49:623-627. [PMID: 28161840 DOI: 10.1007/s11255-017-1522-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To survey long-term outcomes of dialysis patients with urothelial cancers who have undergone complete urinary tract exenteration (bilateral nephroureterectomy and cystectomy). METHODS We retrospectively reviewed our patients with urinary tract urothelial cancer. Forty-two dialysis patients who underwent complete urinary tract exenteration were enrolled in our study. Seventeen patients had undergone one-stage complete urinary tract exenteration, and twenty-five patients had undergone multi-stage surgery. We reviewed the demographic, clinical, surgical, and pathological data to determine the clinical and pathologic variables that affected the survival between the two groups. RESULTS Baseline demographics were comparable in both groups. There was no significant difference in age, American Society of Anesthesiologists class, Charlson index, or body mass index between the two groups. Furthermore, there was no statistically significant difference in estimated blood loss (1280 vs. 1440 ml) or total hospital stay (31 vs. 21 days). Simultaneous upper and lower tract tumors were noted in one-stage CUTE group In comparison with multi-stage surgery, one-stage surgery was associated with a higher complication rate (58.8 vs. 28%). Twenty-two patients were still alive at the end of the study, and 20 had died. The median survival period after confirmation of complete urinary tract exenteration status was 27.5 months. The overall survival was the same between the two groups. The Charlson comorbidity index was a mandatory indicator to predict long-term survival outcome. CONCLUSIONS In dialysis patients with urothelial cancers who have undergone complete urinary tract exenteration, one-stage complete urinary tract exenteration had a high perioperative complication rate. The Charlson comorbidity index was a mandatory indicator to predict long-term survival outcome.
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Matsumoto S, Takayama T, Wakatsuki K, Tanaka T, Migita K, Nakajima Y. Short-term and long-term outcomes after gastrectomy for gastric cancer in patients with chronic kidney disease. World J Surg 2015; 38:1453-60. [PMID: 24378553 DOI: 10.1007/s00268-013-2436-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The incidence of chronic kidney disease (CKD) is increasing, which might be an obstacle to various aspects of gastric cancer treatment, such as perisurgical management and postsurgical follow-up. The present study aimed to evaluate the short- and long-term surgical outcomes following gastrectomy in patients with CKD. METHODS We retrospectively analyzed surgical complications and prognosis of patients with gastric cancer. These patients were divided into three groups according to the glomerular filtration rate (GFR): 49 patients with severe CKD (GFR < 29 ml/min/1.73 m(2)), 128 with mild CKD (GFR 30-59), and 798 in the controls (GFR ≥ 60). RESULTS The incidences of anastomotic leakage and intraabdominal abscess in the mild and severe CKD groups were higher than that in the control group. The incidences of wound infection, cardiovascular and pulmonary events, and in-hospital mortality in the severe CKD group were higher than those in the other two groups. Severe surgical complications were associated with co-morbidities other than CKD, serum albumin level, estimated blood loss, surgery duration in the mild and severe CKD group. The 3-year overall survival rates for the severe CKD, mild CKD, and control groups were 48.6, 80.9, and 85.0 %, respectively, indicating significant differences between the severe CKD group and other two groups. CONCLUSIONS Patients with severe CKD show an increased risk of morbidity and mortality following gastrectomy, and their prognosis is usually poor. Studies with a large cohort are essential to refine the risk stratification for gastrectomy in this high-risk population.
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Affiliation(s)
- Sohei Matsumoto
- Department of Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan,
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Therrien A, Giard JM, Hebert MJ, Bouin M. Importance of pre-transplant colonoscopy in renal transplant recipients. J Clin Med Res 2014; 6:414-21. [PMID: 25247014 PMCID: PMC4169082 DOI: 10.14740/jocmr1934w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 12/19/2022] Open
Abstract
Background Current recommendations for colorectal cancer screening for kidney transplant candidates are the same as for the general population. However, few studies have established the prevalence and characteristics of colorectal polyps in this population. The aim of this study is to describe the prevalence and characteristics of colonic lesions detected by pre-transplant colonoscopies in our kidney transplant population. Methods A retrospective study was conducted from January 2007 to December 2009 at the Centre Hospitalier de l’Universite de Montreal (Canada). Inclusion criteria are all renal transplant recipients with a test for colorectal cancer screening in the 5 years preceding the transplantation. Patients benefiting of a second transplantation were excluded. The files were reviewed for clinical data, including colonoscopy indication, endoscopic and pathologic results. Advanced lesions were defined as adenomas of 10 mm or greater or with a villous component. Polyps were considered proximal if they were at the level of or above the splenic angle. Results This study includes 159 patients. A pre-transplant colonoscopy was performed in 40% (n = 64). Polyps were present in 32.8% (n = 21) of colonoscopies and 66.7% of them showed adenomas. Advanced lesions were present in 6.25% of the exams. Finally, 66.7% of patients with polyps had at least one proximal lesion. Conclusions The prevalence of colorectal polyps before transplant is high among renal transplant recipients. The high prevalence of proximal lesions supports the need for total colonoscopy.
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Affiliation(s)
- Amelie Therrien
- Department of Medicine, Division of Gastroenterology, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Canada
| | - Jeanne-Marie Giard
- Department of Medicine, Division of Gastroenterology, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Canada
| | - Marie-Josee Hebert
- Department of Medicine, Nephrology - Transplantation Unit, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Canada
| | - Mickael Bouin
- Department of Medicine, Division of Gastroenterology, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Canada
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Brambilla M, De Mauri A, Lizio D, Matheoud R, De Leo M, Carriero A. Estimated radiation risk of cancer from medical imaging in haemodialysis patients. Nephrol Dial Transplant 2014; 29:1680-6. [DOI: 10.1093/ndt/gfu080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moffitt T, Hariton F, Devlin M, Garrett PJ, Hannon-Fletcher MPA. Oxidative DNA Damage Is Elevated in Renal Patients Undergoing Haemodialysis. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojpm.2014.46049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Iff S, Craig JC, Turner R, Chapman JR, Wang JJ, Mitchell P, Wong G. Reduced Estimated GFR and Cancer Mortality. Am J Kidney Dis 2014; 63:23-30. [DOI: 10.1053/j.ajkd.2013.07.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/05/2013] [Indexed: 12/22/2022]
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18
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Lee D, Chun JS, Hong SK, Kang MS, Seo JK, Koh JK, Sung HS. Kaposi sarcoma in a patient with chronic renal failure undergoing dialysis. Ann Dermatol 2013; 25:475-8. [PMID: 24371396 PMCID: PMC3870217 DOI: 10.5021/ad.2013.25.4.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 11/08/2022] Open
Abstract
Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.
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Affiliation(s)
- Deborah Lee
- Department of Dermatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Sung Chun
- Department of Dermatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soon-Kwon Hong
- Department of Dermatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi-Seon Kang
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong-Keun Seo
- Department of Dermatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae-Kyoung Koh
- Department of Dermatology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho-Suk Sung
- Department of Dermatology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Malignant tumors in patients with end stage renal failure undergoing renal replacement therapy. Contemp Oncol (Pozn) 2012; 16:382-7. [PMID: 23788914 PMCID: PMC3687441 DOI: 10.5114/wo.2012.31765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/25/2012] [Accepted: 02/15/2012] [Indexed: 12/16/2022] Open
Abstract
In 1975 Matas and co-workers were the first in the world literature to show an increased risk of malignant tumor occurrence in the group of hemodialyzed patients and kidney transplant recipients. The report is an analysis of world literature from the last 35 years in reference to epidemiology as well as the profile of screening tests and diagnostic methods related to malignant tumors in the population with end stage renal disease, especially hemodialyzed patients.
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Lazarev I, Bogomolni L, Shani-Shrem N, Shnaider A, Ariad S, Mermershtain W. Successful treatment of mediastinal seminoma in a hemodialysis patient. ONKOLOGIE 2012; 35:275-8. [PMID: 22868508 DOI: 10.1159/000338481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extragonadal germ cell tumors (GCTs) are relatively uncommon neoplasms, affecting primarily men during the third and fourth decades of life. CASE REPORT We describe an unusual case of mediastinal seminoma in a 21-year-old male on chronic peritoneal dialysis for renal failure of uncertain etiology. The patient was treated with chemotherapy consisting of etoposide and cisplatin (EP) combined with hemodialysis. Cisplatin (20 mg/m(2)), and etoposide (50 mg/m(2)) were given on days 1, 3, and 5 for induction. Hemodialysis was started 1 h after completion of etoposide infusion. Following this course of treatment, another 4 cycles of cisplatin (20 mg/m(2)), and etoposide (50 mg/m(2)) were given on successive days from day 1 to 5. Hemodialysis was carried out daily, prior to the start of chemotherapy. Subcutaneous PEG-filgrastim was given on day 6 in all cycles. The patient's status after the first post-induction treatment was complicated by a pseudomonas infection. Tumor response to chemotherapy was prompt with remission lasting to date, 17 months after diagnosis. CONCLUSION This case report is the second description of chemotherapy given to a hemodialysis patient with extragonadal GCT. We suggest that treatment with EP combined with hemodialysis according to the presented protocol is feasible, and may result in a favorable outcome.
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Affiliation(s)
- Irena Lazarev
- Department of Oncology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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21
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Shebl FM, Warren JL, Eggers PW, Engels EA. Cancer risk among elderly persons with end-stage renal disease: a population-based case-control study. BMC Nephrol 2012; 13:65. [PMID: 22834953 PMCID: PMC3441292 DOI: 10.1186/1471-2369-13-65] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/11/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) have elevated cancer risk. Cancer risk increases with age, but associations of ESRD with specific malignancies are incompletely studied for older individuals. METHODS We conducted a population-based case-control study (1,029,695 cancer and 99,610 controls) among the U.S. elderly using SEER-Medicare linked data. We defined ESRD as presence of dialysis claims in the 3 months prior to selection. RESULTS Although ESRD was not associated with excess cancer risk overall (odds ratio 1.02; 95%CI 0.91-1.14), risk was specifically increased for cancers of the stomach (1.45; 1.16-1.81), small intestine (1.92; 1.27-2.92), colon (1.17; 1.00-1.36), liver (1.53; 1.16-2.01), biliary tract (1.78; 1.20-2.65), lung (1.17; 1.02-1.34), cervix (2.12; 1.39-3.23), kidney (2.42; 2.01-2.92), and for multiple myeloma (1.77; 1.40-2.24) and chronic myeloid leukemia (1.74; 1.08-2.80). The association between liver cancer and ESRD was attenuated upon adjustment for hepatitis B and C infection or diabetes mellitus. Multiple myeloma risk was highest with short ESRD duration (p < 0.0001), possibly reflecting reverse causality, while kidney cancer risk showed a borderline rise over time (p = 0.08). CONCLUSIONS Among elderly individuals with ESRD, the excess risks for some cancers may reflect immune dysfunction or a high prevalence of other risk factors, such as viral infections or diabetes mellitus. Our results underscore the need for studying biological pathways of carcinogenesis in ESRD.
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Affiliation(s)
- Fatma M Shebl
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA.
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22
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Abstract
BACKGROUND Aims of this study were to describe the prevalence of comorbidity in newly diagnosed elderly cancer cases compared with the background population and to describe its influence on overall and cancer mortality. METHODS Population-based study of all 70+ year-olds in a Danish province diagnosed with breast, lung, colorectal, prostate, or ovarian cancer from 1 January 1996 to 31 December 2006. Comorbidity was measured according to Charlson's comorbidity index (CCI). Prevalence of comorbidity in newly diagnosed cancer patients was compared with a control group by conditional logistic regression, and influence of comorbidity on mortality was analysed by Cox proportional hazards method. RESULTS A total of 6325 incident cancer cases were identified. Elderly lung and colorectal cancer patients had significantly more comorbidity than the background population. Severe comorbidity was associated with higher overall mortality in the lung, colorectal, and prostate cancer patients, hazard ratios 1.51 (95% CI 1.24-1.83), 1.41 (95% CI 1.14-1.73), and 2.14 (95% CI 1.65-2.77), respectively. Comorbidity did not affect cancer-specific mortality in general. CONCLUSION Colorectal and lung cancer was associated with increased comorbidity burden in the elderly compared with the background population. Comorbidity was associated with increased overall mortality in elderly cancer patients but not consistently with cancer-specific mortality.
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Hirotsu C, Tufik S, Ribeiro DA, Alvarenga TA, Andersen ML. Genomic damage in the progression of chronic kidney disease in rats. Brain Behav Immun 2011; 25:416-22. [PMID: 20974244 DOI: 10.1016/j.bbi.2010.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/16/2022] Open
Abstract
Patients with chronic renal failure exhibit massive oxidative genome damage and an elevated risk of cancer. Previous studies have demonstrated the relationship between DNA damage and carcinogenesis. The current study aimed to investigate whether the progression of chronic kidney disease induces genomic damage in an animal model. Adult Wistar rats were assigned to either the control or chronic kidney disease groups. The chronic kidney disease group was subdistributed into five groups with progressively longer durations of disease (30, 60, 90, 120 and 150 days). The results showed that chronic kidney disease induced genomic damage in the blood, liver and kidney cells during all periods evaluated, as indicated by the mean tail moment measured in the comet assay. In brain cells, no genetic damage was induced at early/intermediate disease durations; however, positive genotoxicity was found at 120 and 150 days. Blood pressure and pro-inflammatory cytokine levels (IL-1α, IL-1β, IL-6 and TNFα) were increased after chronic kidney disease induction, while blood iron concentration was significantly reduced in these animals. The results suggest that chronic kidney disease progression contributes to DNA damage in blood, liver, kidney and brain and that such damage can be mediated by hypertension, an inflammatory status and iron deficiency. Additionally, the brain was sensitive to genotoxic insult after extended chronic kidney disease, suggesting a potentially important role of genetic damage in the neurological disorders of end-stage renal patients.
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Affiliation(s)
- Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Nakayama H, Miyazaki S, Kikuchi H, Saito N, Shimada H, Sakai S, Suzuki M, Kimura K. Malignant vaginal melanoma with metastases to the papilla of Vater in a dialysis patient: a case report. Intern Med 2011; 50:345-9. [PMID: 21325769 DOI: 10.2169/internalmedicine.50.4564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Malignant vaginal melanoma is an extremely rare clinical condition, with less than 150 cases reported to date. A dialysis patient had primary vaginal melanoma with metastases to the papilla of Vater. Gastroduodenoscopy revealed a polypoid tumor. Histological findings revealed vimentin, S-100 protein, HMB45, MelanA-positive sarcoma-like cells. This staining pattern indicated that this tumor was a malignant melanoma of the papilla. Analysis of an autopsy specimen of the papilla of Vater revealed metastasis from the primary vaginal melanoma. Metastasis of a malignant tumor to the gastrointestinal tract, especially to the papilla, is uncommon. Melanoma should be considered in the differential diagnosis of primary gastrointestinal tract malignancy.
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Affiliation(s)
- Hitoshi Nakayama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Shinrakuen Hospital, Japan.
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25
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Spectrum of abdominal pathologies detected with CT in long term dialysis patients. Eur J Radiol 2009; 72:306-13. [DOI: 10.1016/j.ejrad.2008.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 07/04/2008] [Indexed: 11/22/2022]
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26
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Li WM, Li CC, Ke HL, Wu WJ, Huang CN, Huang CH. The Prognostic Predictors of Primary Ureteral Transitional Cell Carcinoma After Radical Nephroureterectomy. J Urol 2009; 182:451-8; discussion 458. [PMID: 19524962 DOI: 10.1016/j.juro.2009.04.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Nung Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hsiung Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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27
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Ribeiro DA, Campos RR, Bergamaschi CT. Chronic renal failure induces genetic instability in multiple organs of Wistar rats. Eur J Clin Invest 2009; 39:289-95. [PMID: 19292884 DOI: 10.1111/j.1365-2362.2009.02100.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Taking into consideration the strong evidence for a relationship between DNA damage and carcinogenesis, the aim of this study was to investigate whether blood, liver, heart, kidney and brain are particularly sensitive organs for DNA damaging during chronic renal disease by the single-cell gel (comet) assay to predict genetic instability induced by this pathological condition. METHODS A total of 18 male Wistar rats were divided into two groups: negative control (n = 8) and experimental (n = 10), in which was submitted to the 5/6 renal mass ablation by ligation of two or three branches of the left renal artery and total right nephrectomy during 8 weeks. RESULTS The results showed that chronic renal disease was able to induce genetic damage in blood, heart, liver and kidney cells as depicted by the mean tail moment. No genetic damage was induced in brain cells, i.e. no significant statistically differences (P > 0.05) were noticed when compared to negative control. CONCLUSION In conclusion, our results suggest that chronic renal failure could contribute to the damage of DNA at all organs evaluated, except to the brain cells. As DNA damage is an important step in events leading to carcinogenesis, this study represents a relevant contribution to the correct evaluation of the potential health risks associated with kidney disease.
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Affiliation(s)
- D A Ribeiro
- Department of Biosciences, Federal University of Sao Paulo, UNIFESP, Santos, SP, Brazil.
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28
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Li CC, Wang HS, Wu WJ, Chou YH, Liu CC, Long CY, Hus SC, Chuang CH, Jang MY, Huang SP, Juan YS, Huang CH. Laparoscopic complete urinary tract exenteration with the specimen withdrawn transvaginally. BJU Int 2009; 104:82-6. [PMID: 19154504 DOI: 10.1111/j.1464-410x.2008.08339.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the technique of laparoscopic complete urinary tract exenteration (LaCUTE), where specimens are withdrawn en bloc through the vagina, and to compare our results for patients had this procedure with those who had surgery by traditional open methods PATIENTS AND METHODS From February 2006 to June 2008, five patients had LaCUTE and three CUTE at our institute. The surgical procedure included bilateral nephroureterectomy, bilateral pelvic lymphadenectomy, radical cystourethrectomy, radical hysterectomy, bilateral salpingo-oophorectomy. RESULTS In the LaCUTE group the mean (range) patient age was 58 (46-73) years, the blood loss was 378 (290-490) mL, the operative duration was 492 (405-560) min and the hospital stay was 12.2 (9-17) days. All patients had negative surgical margins on pathological examination. The LaCUTE group had significantly less blood loss but longer surgery than the open group. At a mean follow-up of 14.5 and 16.0 months, respectively, there was no evidence of recurrent cancer in both groups. CONCLUSIONS With further experience and improvement in surgical techniques, LaCUTE with vaginal specimen en bloc withdrawal will become feasible for uraemic female patients with urothelial cancer.
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Affiliation(s)
- Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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Lee JE, Han SH, Cho BC, Park JT, Yoo TH, Kim BS, Park HC, Kang SW, Lee HY, Han DS, Ha SK, Choi KH. Cancer in patients on chronic dialysis in Korea. J Korean Med Sci 2009; 24 Suppl:S95-S101. [PMID: 19194570 PMCID: PMC2633193 DOI: 10.3346/jkms.2009.24.s1.s95] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 12/24/2008] [Indexed: 11/20/2022] Open
Abstract
The study of cancer in patients treated with dialysis in Korea has not been reported. The aim of this study was to investigate the incidence and mortality of cancer among patients on dialysis in Korea. The study subjects were 106 cancer patients (2.3%) out of 4,562 end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) or peritoneal dialysis (PD) at Yonsei University Health System from 1996 to 2005. We excluded patients in whom the diagnosis of cancer preceded dialysis or those who received renal allograft or started dialysis after renal allograft. Seventy-three (69%) of our subjects were male and 33 (31%) were female. The mean age at the time of cancer diagnosis was 57.9+/-11.7 yr. The mean time from the start of dialysis to the diagnosis of cancer was 75.2+/-63.9 months. The most common cancer site was gastrointestinal tract (GIT) (51%) followed by urinary tract (20%), lung (8%), and thyroid (7%). Sixty nine percent of the total mortality was due to cancer. The mean time from diagnosis to death was 2.9+/-2.5 yr. In ESRD patients with cancer, there were no significant differences in mortality rates by dialysis modality. In ESRD patients, the most common cancer was GIT cancer followed by urinary tract cancer. Therefore, careful surveillance of these cancers in ESRD patients is highly recommended.
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Affiliation(s)
- Jung Eun Lee
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Chul Cho
- Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Tak Park
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Yoo
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Yung Lee
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Suk Han
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyu Ha
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Hun Choi
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Haberal AN, Bilezikçi B, Ozen O, Yalçinkaya C, Arat Z, Kuşçu E, Demirhan B. Pap smear findings in chronic renal failure patients compared with the normal population according to Bethesda 2001. Diagn Cytopathol 2008; 36:776-9. [PMID: 18831015 DOI: 10.1002/dc.20905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dialysis remains the most common treatment for end-stage renal disease (ESRD). Although the increased risk of cancer after renal transplant is well documented, there is less certainty about the risk of cancer in patients treated only with dialysis. From 1997 to 2002, 262 ESRD patients received a Pap test at Başkent University. The smears of 149 patients who had ESRD for more than 9 months were compared with the smears of 150 otherwise healthy patients. All of the Pap smears were re-examined according to Bethesda 2001 criteria. The mean age of the patients was 42.88 years. Regarding micro-organisms, no statistically significant difference between the groups were observed. In 36 Pap smears, a shift in flora suggestive of bacterial vaginosis was detected. There were statistically significant differences between the groups. When age was considered as a marker of atrophy, atrophy in patients younger than 50 years was statistically different between the groups. Also, we determined that the shift in flora suggestive of bacterial vaginosis and atrophy in patients aged younger than 50 years did not depend on the length of hemodialysis. Of 13 patients (4.3%) who had epithelial cell abnormalities there were not statistically significant differences between the groups. In conclusion, according to our study, CRF seems not to be a predictive factor for cervical cancer. Shift in flora suggestive of bacterial vaginosis and atrophy in patients aged younger than 50 years might be the natural effects of uremia, and they appear not to be dependent on the length of the hemodialysis period.
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Klaunig JE, Babich MA, Baetcke KP, Cook JC, Corton JC, David RM, DeLuca JG, Lai DY, McKee RH, Peters JM, Roberts RA, Fenner-Crisp PA. PPARα Agonist-Induced Rodent Tumors: Modes of Action and Human Relevance. Crit Rev Toxicol 2008; 33:655-780. [PMID: 14727734 DOI: 10.1080/713608372] [Citation(s) in RCA: 445] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Widely varied chemicals--including certain herbicides, plasticizers, drugs, and natural products--induce peroxisome proliferation in rodent liver and other tissues. This phenomenon is characterized by increases in the volume density and fatty acid oxidation of these organelles, which contain hydrogen peroxide and fatty acid oxidation systems important in lipid metabolism. Research showing that some peroxisome proliferating chemicals are nongenotoxic animal carcinogens stimulated interest in developing mode of action (MOA) information to understand and explain the human relevance of animal tumors associated with these chemicals. Studies have demonstrated that a nuclear hormone receptor implicated in energy homeostasis, designated peroxisome proliferator-activated receptor alpha (PPARalpha), is an obligatory factor in peroxisome proliferation in rodent hepatocytes. This report provides an in-depth analysis of the state of the science on several topics critical to evaluating the relationship between the MOA for PPARalpha agonists and the human relevance of related animal tumors. Topics include a review of existing tumor bioassay data, data from animal and human sources relating to the MOA for PPARalpha agonists in several different tissues, and case studies on the potential human relevance of the animal MOA data. The summary of existing bioassay data discloses substantial species differences in response to peroxisome proliferators in vivo, with rodents more responsive than primates. Among the rat and mouse strains tested, both males and females develop tumors in response to exposure to a wide range of chemicals including DEHP and other phthalates, chlorinated paraffins, chlorinated solvents such as trichloroethylene and perchloroethylene, and certain pesticides and hypolipidemic pharmaceuticals. MOA data from three different rodent tissues--rat and mouse liver, rat pancreas, and rat testis--lead to several different postulated MOAs, some beginning with PPARalpha activation as a causal first step. For example, studies in rodent liver identified seven "key events," including three "causal events"--activation of PPARalpha, perturbation of cell proliferation and apoptosis, and selective clonal expansion--and a series of associative events involving peroxisome proliferation, hepatocyte oxidative stress, and Kupffer-cell-mediated events. Similar in-depth analysis for rat Leydig-cell tumors (LCTs) posits one MOA that begins with PPARalpha activation in the liver, but two possible pathways, one secondary to liver induction and the other direct inhibition of testicular testosterone biosynthesis. For this tumor, both proposed pathways involve changes in the metabolism and quantity of related hormones and hormone precursors. Key events in the postulated MOA for the third tumor type, pancreatic acinar-cell tumors (PACTs) in rats, also begin with PPARalpha activation in the liver, followed by changes in bile synthesis and composition. Using the new human relevance framework (HRF) (see companion article), case studies involving PPARalpha-related tumors in each of these three tissues produced a range of outcomes, depending partly on the quality and quantity of MOA data available from laboratory animals and related information from human data sources.
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Affiliation(s)
- James E Klaunig
- Indiana University School of Medicine, Indianapolis, IN, USA
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32
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LeBrun CJ, Yuan CM, Welch PG. A Reconsideration of the Benefits of Cancer Screening in Dialysis Patients. Semin Dial 2008. [DOI: 10.1046/j.1525-139x.1999.99009.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chris J. LeBrun
- Nephrology Services, Departments of Medicine, Madigan Army Medical Center, Tacoma, Washington,
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Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC, Chang SJ, Shen JT, Chou YH, Huang CH. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 2008; 54:1127-34. [PMID: 18243511 DOI: 10.1016/j.eururo.2008.01.054] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 01/17/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To follow up the long-term prognosis of patients who underwent nephroureterectomy for primary upper urinary tract (UUT) cancer and to evaluate the predictive factors of tumour recurrence and survival. METHODS Between January 1990 and June 2005, 260 patients with primary UUT transitional cell carcinoma (TCC) underwent radical nephroureterectomy at our institution. The medical records of these patients were retrospectively reviewed. The clinical and histopathological data were analyzed to evaluate predictive factors. RESULTS The median follow-up time was 52 mo. In total, 89 patients (34.1%) developed subsequent bladder tumours. Predictive factors of bladder tumour recurrence were being male and having renal insufficiency. Local recurrence developed in 16 patients (6.2%); only the tumour stage was significantly associated with local recurrence. Metachronous contralateral UUT tumour was diagnosed in 12 patients (4.6%), with gender being the only predictive factor. Of the 260 patients, 167 (63.9%) were disease-free and alive at a median follow-up of 56.5 mo, and 45 (17.2%) died of urothelial cancer at a median period of 20 mo. Only the tumour stage was a prognostic factor to predict cancer-specific survival. CONCLUSIONS In patients with UUT-TCC after radical nephroureterectomy, tumour stage is the only prognostic factor for both local recurrence and cancer-specific survival. Male patients with renal insufficiency should be alerted to the possibility of bladder tumour recurrence. Because female patients were more likely to develop contralateral recurrences, renal ultrasonography, intravenous pyelography, or retrograde pyelography should be performed more frequently for female patients who live in the high-prevalence area.
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Affiliation(s)
- Ching-Chia Li
- Department of Urology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hano JE. HEALTH SCREENING: III. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1994.tb00928.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mori S, Sawada T, Hamada K, Kita J, Shimoda M, Tagaya N, Kubota K. Gastrectomy for patients with gastric cancer and non-uremic renal failure. World J Gastroenterol 2007; 13:4589-92. [PMID: 17729411 PMCID: PMC4611832 DOI: 10.3748/wjg.v13.i34.4589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the safety and outcome of gastrectomy for patients with gastric cancer and non-uremic renal failure (NURF).
METHODS: One hundred forty-seven patients who underwent gastrectomy for carcinoma were retrospectively divided into two groups: a group with Ccr values of ≥ 50 mL/min (Group 1; n = 110), and one with Ccr values of ≥ 20 to < 50 mL/min (Group 2; n = 37). Preoperative patient characteristics, intraoperative parameters (including operation time and blood loss), and postoperative management and complications were evaluated.
RESULTS: There were no statistically significant differences between the two groups in operation time (297.9 min vs 272.6 min, P = 0.137) or blood loss (435 mL vs 428 mL, P = 0.078). The differences in postoperative complications and hospital stay between the groups were not statistically significant. None of the patients in Group 2 required dialysis therapy, and no patients died due to gastrectomy or gastrectomy-related causes. The overall 4-year survival rates in Groups 1 and 2 were 86.6% and 81.8%, respectively (P = 0.48), and the corresponding 4-year disease-free survival rates for stageI, II, and III patients were 88.7% and 83.5%, respectively (P = 0.65).
CONCLUSION: Gastrectomy can be performed as safely in patients with NURF similar to patients with normal renal function.
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Affiliation(s)
- Shozo Mori
- Second Department of Surgery, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi, Japan
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Sebeková K, Wagner Z, Schupp N, Boor P. Genomic Damage and Malignancy in End-Stage Renal Failure: Do Advanced Glycation End Products Contribute? Kidney Blood Press Res 2006; 30:56-66. [PMID: 17261927 DOI: 10.1159/000099029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Indexed: 01/28/2023] Open
Abstract
In end-stage renal disease (ESRD) there is not only excessive morbidity and mortality due to cardiovascular disease but also an enhanced occurrence of various types of cancer. Both are characterized by oxidative stress and inflammation as two of the central underlying causes of the disease states. In cancer, genomic damage has been demonstrated to be of high pathogenetic relevance. DNA lesions may induce mutations of oncogenes and tumor-suppressor genes which, in the long-run, may lead to malignancies if mutagenicity is not mitigated by repair mechanisms. A high incidence of genomic damage in ESRD patients has been validated by various biomarkers of DNA lesions. We reviewed the mechanisms of DNA damage, focusing in particular on the role of advanced glycation end products (AGEs) which accumulate markedly in renal insufficiency. Considering the in vitro and in vivo findings to date, one has to assume a significant role of AGEs in DNA damage and the potential development of cancer.
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Affiliation(s)
- Katarína Sebeková
- Department of Experimental and Clinical Pharmacotherapy, Research Base of Slovak Medical University, Bratislava, Slovakia.
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Bini EJ, Kinkhabwala A, Goldfarb DS. Predictive Value of a Positive Fecal Occult Blood Test Increases as the Severity of CKD Worsens. Am J Kidney Dis 2006; 48:580-6. [PMID: 16997054 DOI: 10.1053/j.ajkd.2006.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 07/05/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Because chronic kidney disease (CKD) may be associated with gastrointestinal bleeding from trivial mucosal lesions, we hypothesized that the predictive value of a positive fecal occult blood test (FOBT) result for clinically important colonic lesions would decrease as the stage of CKD worsened. METHODS We prospectively identified 1,225 consecutive asymptomatic average-risk patients who were referred for colonoscopy to evaluate a positive FOBT result. Using the Modification of Diet in Renal Disease equation, we estimated glomerular filtration rate (GFR) and staged the severity of CKD by using standard criteria as follows: normal/stage 1 (GFR > or = 90 mL/min/1.73 m2 [> or = 1.50 mL/s]), stage 2/3 (GFR 30 to 89 mL/min/1.73 m2 [0.50 to 1.48 mL/s]), and stage 4/5 (GFR < 30 mL/min/1.73 m2 [< 0.50 mL/s] or dialysis). RESULTS Clinically important lesions were identified in 23.9% of 531 individuals with none/stage 1 CKD, 32.8% of 497 subjects with stage 2/3 CKD, and 42.6% of 197 patients with stage 4/5 CKD (P < 0.001). Compared with patients with none/stage 1 CKD, adjusted odds of identifying a clinically important lesion were 1.61 (95% confidence interval, 1.21 to 2.15) in subjects with stage 2/3 CKD and 2.33 (95% confidence interval, 1.62 to 3.36) in patients with stage 4/5 CKD. Prevalences of adenomas of 1 cm or greater (15.1% versus 20.1% versus 22.8%; P = 0.007), carcinomas (5.1% versus 10.1% versus 13.2%; P < 0.001), and vascular ectasias (1.7% versus 2.4% versus 6.1%; P = 0.003) increased with the severity of CKD. CONCLUSION Contrary to our initial hypothesis, we found that the predictive value of a positive FOBT result for clinically important colonic lesions increased as the severity of CKD worsened.
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Affiliation(s)
- Edmund J Bini
- Division of Gastroenterology, Veterans Affairs New York Harbor Healthcare System, New York, NY 10010, USA.
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Wu CF, Chang PL, Chen CS, Chuang CK, Weng HH, Pang ST. The Outcome of Patients on Dialysis With Upper Urinary Tract Transitional Cell Carcinoma. J Urol 2006; 176:477-81. [PMID: 16813872 DOI: 10.1016/j.juro.2006.03.099] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Transitional cell carcinoma is the most common upper urinary tract cancer in Taiwanese patients on dialysis. It is a unique finding compared with Western countries. Unfortunately, the long-term outcomes of patients with upper urinary tract transitional cell carcinoma on dialysis are largely unknown. This study presents clinical outcome of patients on dialysis with upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS We retrospectively reviewed the medical records of all patients with upper urinary tract transitional cell carcinoma who had end stage renal disease and underwent dialysis. Traditional prognostic factors including age, sex, tumor grade, stage and tumor location were analyzed with respect to disease recurrence and survival. RESULTS A total of 73 patients were included in this study. The major complaints were painless gross hematuria and urethral bloody discharge. Disease relapsed in 40 (54.8%) patients at average time of 15 months (2 to 92). Univariate analysis failed to identify significant prognostic factors for recurrence. The average duration between primary and contralateral metachronous upper urinary tract transitional cell carcinoma recurrence was 36 months (range 5 to 96). Patients on dialysis with upper urinary tract transitional cell carcinoma who had previous or concurrent bladder tumor, or who had a history of recurrent bladder tumor, had high contralateral upper urinary tract transitional cell carcinoma recurrence. (p = 0.038) The statistically significant prognostic factor for disease-free survival was pT stage (p = 0.041). CONCLUSIONS Patients on dialysis with painless gross hematuria or bloody urethral discharge must undergo detail urinary system evaluation. Since patients with upper urinary tract transitional cell carcinoma on dialysis have a high recurrence rate and metachronous or even multiple, early synchronous tumor characteristics that may be missed by imaging, total urinary tract exenteration is a recommended therapeutic option.
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Affiliation(s)
- Ching-Fang Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
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Horiuchi K, Uchikoba T, Oka F, Sato M, Kondo Y, Kimura G, Tsuboi N, Yoshida K, Nishimura T. Transitional Cell Carcinoma of the Bladder in Four Patients on Maintenance Hemodialysis. J NIPPON MED SCH 2004; 71:408-11. [PMID: 15673962 DOI: 10.1272/jnms.71.408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report four patients on maintenance hemodialysis (HD) with transitional cell carcinoma (TCC) of the bladder. Three patients underwent transurethral resection (TUR) of their tumors, which were grade 2 or 3, stage pT1 TCC. Among them, one patient underwent repeat TUR for recurrent superficial TCC. The remaining one patient underwent total cystectomy for grade 3, stage pT4 TCC and squamous cell carcinoma of the bladder. Subsequently, he died suddenly without evidence of local recurrence or systemic metastasis. We discuss the relationship between the duration of HD and the tumor grade and stage of primary bladder TCC in maintenance HD patients.
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Affiliation(s)
- Kazutaka Horiuchi
- Department of Urology, Nippon Medical School, Kanagawa 211-8533, Japan.
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Wu CF, Shee JJ, Ho DR, Chen WC, Chen CS. Different Treatment Strategies for End Stage Renal Disease in Patients With Transitional Cell Carcinoma. J Urol 2004; 171:126-9. [PMID: 14665859 DOI: 10.1097/01.ju.0000101758.41635.28] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Transitional cell carcinoma is the most common urinary tract cancer in Taiwanese patients on dialysis. It is a unique finding compared within Western countries. Due to this geographic difference and a higher recurrence rate a more extensive operation and aggressive followup protocols should be refined for these patients on dialysis. MATERIALS AND METHODS We retrospectively reviewed the medical records of all patients with transitional cell carcinoma who had end stage renal disease and underwent hemodialysis. Records were reviewed for hemodialysis duration, initial tumor location, tumor grade, stage, operative method, operative complication and final surgical status. Tumor grade and stage was determined by the WHO and proposed Jewett systems. Six patient groups were classified according to final surgical status for comparative analysis. RESULTS A total of 30 patients were included in this study. Painless gross hematuria and urethral bloody discharge were the most common complaints. Tumor in 25 of the 30 cases was high grade and all were early stage. Of the patients 11 (36.7%) had undergone bilateral nephroureterectomy and radical cystectomy in as a 1 or multiple step procedure. Six patients (20%) had undergone bilateral nephroureterectomy at 1 or 2 sequential operations. Seven of the 13 patients (53.8%) in whom low urinary tract transitional cell carcinoma was initially treated with transurethral resection unfortunately had recurrent transitional cell carcinoma of the upper urinary tract. Ten of the 14 patients (71.4%) with upper urinary tract transitional cell carcinoma who underwent nephroureterectomy and bladder cuff excision had subsequent transitional cell carcinoma within the bladder. CONCLUSIONS Patients with transitional cell carcinoma on dialysis had a higher recurrence rate in the upper urinary tract than patients not on dialysis. Most cases were at an early stage but with high grade tumor behavior. In 11 patients (36.7%) total exenteration of the urinary tract except the urethra was eventually done. The final bilateral nephroureterectomy rate was 56.7%. Since the rate of total exenteration and bilateral nephrectomy was abnormally high at such a short followup, 1-step bilateral nephroureterectomy and radical cystectomy are a recommended treatment for patients with transitional cell carcinoma on dialysis.
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Affiliation(s)
- Ching-Fang Wu
- Department of Surgery, Chang Gung Memorial Hospital, Chia-Ya, Taiwan, Republic of China
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Winkelmayer WC, Owen W, Glynn RJ, Levin R, Avorn J. Preventive health care measures before and after start of renal replacement therapy. J Gen Intern Med 2002; 17:588-95. [PMID: 12213139 PMCID: PMC1495089 DOI: 10.1046/j.1525-1497.2002.11021.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe utilization of preventive health care measures in patients with chronic kidney disease (CKD), both in the year prior to onset of renal replacement therapy (RRT), and in the first year of RRT. METHODS We identified a large cohort of patients with CKD in the New Jersey Medicaid and Medicare programs with fixed enrollment into the cohort at 1 year prior to RRT. We applied commonly used quality assurance instruments (Health Plan Employer Data and Information Set measures) and defined levels and correlates of use of preventive care measures before and after RRT. These included mammography, Pap smear testing, prostate cancer screening, diabetic eye exams, and glycosylated hemoglobin testing (HbA1c). We employed logistic regression models with adjustment for age, race, gender, comorbidity, timing of first nephrologist contact, socioeconomic status, and calendar year of first RRT. RESULTS Overall, screening rates were low with the exception of diabetic eye exams. Prostate cancer screening, diabetic eye exams, and HbA1c testing were performed less often after onset of RRT compared to the year before (P < .05). Although screening rates before RRT improved considerably over the period of observation for these measures (P < .05), this was not the case once patients were on RRT. CONCLUSIONS Preventive health care interventions remain underutilized among RRT patients. Greater attention to such preventive measures could lead to significant improvements in the health status of such vulnerable patients. Thus, quality improvement of the general health care for patients on RRT should become a priority in renal health policy.
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Affiliation(s)
- Wolfgang C Winkelmayer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
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Coutinho HM, Groothoff JW, Offringa M, Gruppen MP, Heymans HS. De novo malignancy after paediatric renal replacement therapy. Arch Dis Child 2001; 85:478-83. [PMID: 11719332 PMCID: PMC1719000 DOI: 10.1136/adc.85.6.478] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine frequency, type, determinants, and outcome of malignancies in children with end stage renal failure. METHODS All Dutch patients, aged less than 15 years, who started chronic renal replacement therapy between 1972 and 1992 and who were at least 18 years old on 1 January 1997, were retrospectively studied. RESULTS Mean follow up from first renal replacement therapy was 15.5 years. Twenty two malignancies were found in 21 of 249 patients. Skin cancer accounted for 59% and non-Hodgkin lymphoma for 23% of malignancies. At 25 years after first renal replacement therapy, the probability of developing a malignancy was 17% (95% CI: 9 to 24%). Compared to the general population the incidence rate for overall cancer was tenfold higher. For non-melanoma skin cancer and non-Hodgkin lymphoma, standardised risks were 222 and 46 respectively. The use of more than 20 mg/kg cyclophosphamide showed an association with increased risk of malignancy. Six patients died as a result of their malignancy, accounting for 9.5% of overall mortality. Whereas four out of five patients with non-Hodgkin lymphoma died, the most frequent malignancy, skin cancer, did not contribute to mortality. CONCLUSION The long term risk of certain malignancies is significantly increased in children who have undergone renal replacement therapy. As an important contributor to overall mortality, awareness of this risk of malignancy in these patients is necessary, especially after treatment with cyclophosphamide.
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Affiliation(s)
- H M Coutinho
- Department of Paediatric Nephrology, Department of Paediatrics, Emma Children's Hospital AMC, University of Amsterdam, 1100 DE Amsterdam, Netherlands
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LeBrun CJ, Diehl LF, Abbott KC, Welch PG, Yuan CM. Life expectancy benefits of cancer screening in the end-stage renal disease population. Am J Kidney Dis 2000; 35:237-43. [PMID: 10676722 DOI: 10.1016/s0272-6386(00)70332-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Health maintenance includes secondary prevention through cancer screening. There are no established guidelines for cancer screening patients with end-stage renal disease (ESRD). Using an established method of estimating life expectancy, published literature on cancer screening, and information from databases on mortality and malignancy (US Renal Data System 1997 Annual Data Report and the SEER Cancer and Statistical Review, 1973-1994), a "real-time life expectancy calculator" was developed to guide the primary help provider in making informed decisions on the benefits of cancer screening in individual patients. Potential days of life saved by each screening method can be calculated using the difference in life expectancy per the DEALE (declining exponential approximation of life expectancy) method with and without cancer screening. Using two sets of assumptions (one to enhance any bias toward support for screening and one to limit this bias), a range of potential days of life saved with screening for breast and colon cancer can be calculated in individual patients with ESRD. In breast cancer, for example, a 50-year-old black woman with ESRD and multiple risk factors would have 41 to 291 potential days of life saved with screening. A 60-year-old white woman with ESRD and diabetes mellitus (DM) would have only 1 to 16 days of life saved. This life expectancy calculator can guide the primary health care provider in making clinical decisions concerning screening in the ESRD population. In addition to assisting in patient education, the calculator can be updated as new information becomes available regarding relative risk, treatment, and mortality.
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Affiliation(s)
- C J LeBrun
- Department of Medicine, Madigan Army Medical Center, Washington, DC, USA
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Heidland A, Bahner U, Vamvakas S. Incidence and spectrum of dialysis-associated cancer in three continents. Am J Kidney Dis 2000; 35:347-51; discussion 352-3. [PMID: 10676739 DOI: 10.1016/s0272-6386(00)70349-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Heidland
- Department of Internal Medicine, University of Würzburg, Germany.
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Johnson JG, Gore SM, Firth J. The effect of age, diabetes, and other comorbidity on the survival of patients on dialysis: a systematic quantitative overview of the literature. Nephrol Dial Transplant 1999; 14:2156-64. [PMID: 10489225 DOI: 10.1093/ndt/14.9.2156] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The UK Renal Registry quotes a 1-year death rate for patients established on dialysis of 19.4 per 100 patient years. Clinical experience, reflected in the UK Renal Association Standards Document (RASD), recognizes qualitatively that age, diabetes, and other comorbidities increase the risk of death. The aim of this paper is to provide quantitative estimates of the relative risk of death associated with particular patient characteristics. METHODS Quantitative techniques were used to estimate relative risk of death in the seven studies quoted in the RASD document and 17 other papers identified in a systematic literature search. Relative risk data from each study were pooled using a fixed effects model (f). A random effects model (r) was applied to pool relative risks if heterogeneity was found to exist between studies. A meta-regression analysis was also carried out to investigate whether study covariates substantially explained the heterogeneity between studies. RESULTS Pooling the papers identified in the systematic literature search with those from the RASD gave rise to a relative risk of death of 1.029 (95% CI 1.013-1.045) (r) associated with each year's increase in age. The relative risk associated with the presence of diabetes was 1.91 (95% CI 1.67-2.17) (r), whilst that associated with heart disease was 1.59 (95% CI 1.49-1.69) (f), and with peripheral vascular disease 1.58 (95% CI 1.29-1.93) (r). Heterogeneity was found in the estimates of risk associated with age, diabetes, and peripheral vascular disease. Important study covariates included the use of incident or prevalent cases, the use of routine data sources or data collected specifically for a particular study, the country in which the study was located, the use of a P value to infer the standard error of a relative risk estimate in a particular study, and the method of classifying diabetes. CONCLUSIONS Published studies can be used to quantify the relative risk of death for dialysis patients with various comorbidities. This information is important if attempts are to be made to set standards for the performance of dialysis units, and to compare the performance of one dialysis unit with that of another.
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Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, Wolfe RA, Jones E, Disney AP, Briggs D, McCredie M, Boyle P. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999; 354:93-9. [PMID: 10408483 DOI: 10.1016/s0140-6736(99)06154-1] [Citation(s) in RCA: 597] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous studies have suggested that the frequency of cancer is higher in patients with end-stage renal disease (ESRD) than in the general population, but have not established whether this increase is confined to certain cancers or to certain categories of ESRD patients. The aim of this study was to examine the risk of cancer in a large cohort of patients treated by dialysis but not transplantation. METHODS We assembled a cohort of 831,804 patients who received dialysis during the period 1980-94 for ESRD in the USA, Europe, Australia, or New Zealand. We compared the observed frequency of cancer among these patients during 2,045,035 person-years of follow-up with the frequency of cancer in the respective background populations. FINDINGS During average follow-up of 2.5 years, 25,044 (3%) of 831,804 patients developed cancer compared with an expected number of 21,185 (standardised incidence ratio 1.18 [95% CI 1.17-1.20]). We observed a higher risk of cancer in patients younger than 35 years (3.68 [3.39-3.99]), and the risk gradually decreased with increasing age. High risks were observed for cancer of the kidney (3.60 [3.45-3.76]), bladder (1.50 [1.42-1.57]), and thyroid and other endocrine organs (2.28 [2.03-2.54]). Excess cancers appeared in several organs for which viruses have been suspected as causative agents, whereas cancers of the lung, colorectum, prostate, breast, and stomach were not consistently increased. INTERPRETATION The overall risk of cancer is increased in patients with ESRD, and the distribution of tumour types resembles the pattern seen after transplantation (although we have no data to make the comparison with skin cancer). The excess risk can largely be ascribed to effects of underlying renal or urinary-tract disease, or of loss of renal function, on the kidney and bladder, and to increased susceptibility to viral carcinogenesis. The relative risk, which is especially high in younger patients, gradually diminishes with age.
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Affiliation(s)
- P Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
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Gulanikar AC, Daily PP, Kilambi NK, Hamrick-Turner JE, Butkus DE. Prospective pretransplant ultrasound screening in 206 patients for acquired renal cysts and renal cell carcinoma. Transplantation 1998; 66:1669-72. [PMID: 9884257 DOI: 10.1097/00007890-199812270-00017] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous studies have reported an increased prevalence of renal cell carcinoma in association with acquired cystic kidney disease (ACKD). In 1995, the clinical practice guidelines of the American Society of Transplant Physicians for evaluation of renal transplant candidates recommend not screening for ACKD and renal cell carcinoma, on the basis of the low frequency of cancer and reported regression of ACKD after transplantation. The objective of this study was to prospectively evaluate the prevalence of ACKD and renal cancer during renal transplant evaluation. METHODS A total of 206 consecutive adult patients evaluated for renal transplantation underwent a routine renal ultrasound. Patients with a suspicious ultrasound underwent a contrasted computed tomographic scan of the kidneys followed by excision of kidneys with solid, enhancing (>10 Hounsfield units) lesions. RESULTS Sixty-three (30.6%) of 206 patients had ACKD, with a greater proportion being male, African-American, and dialysis-dependent for a longer duration. Eight patients (3.8%) had histologically proven localized cancer (six unilateral, two bilateral), seven in association with ACKD and one in association with autosomal dominant polycystic kidney disease. With a mean follow-up of 14 months (range, 3-33 mo), there has been no recurrence. The positive predictive value of a solid lesion on ultrasound was 100% (8 of 8 patients). CONCLUSION With the high prevalence (3.4%) of renal cell carcinoma in association with ACKD and the concern that immunosuppression accelerates the growth of preexisting cancers, we continue to recommend ultrasound screening of the native kidneys before renal transplantation.
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Affiliation(s)
- A C Gulanikar
- Department of Radiology, University of Mississippi Medical Center, Jackson 39216, USA
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Nakahama H, Tanaka Y, Fujita Y, Fujii M, Sugita M. CYFRA 21-1 and ProGRP, tumor markers of lung cancer, are elevated in chronic renal failure patients. Respirology 1998; 3:207-10. [PMID: 9767622 DOI: 10.1111/j.1440-1843.1998.tb00123.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Serum levels of CYFRA 21-1(cytokeratin-19 fragment) and ProGRP (pro-gastrin-releasing peptide), the new prognostic markers of lung cancer, were measured by ELISA (enzyme-linked immunoadsorbent assay) in 27 (for CYFRA 21-1; male 13, female 14; age 54+/-17 years) or 22 (for ProGRP; male 9, female 13; age 59+/-18 years) patients with various serum creatinine levels, 42 haemodialysis (HD) patients (male 24, female 18; age 59+/-14 years) and 30 continuous ambulatory peritoneal dialysis (CAPD) patients (male 18, female 12; age 48+/-9 years). All the patients were without clinical and radiological signs of lung cancer. Positive correlations were found between serum creatinine and serum CYFRA 21-1 and ProGRP levels. Serum levels of CYFRA 21-1 were above the cutoff limit (3.5 ng/mL) in 57% of HD patients (mean 4.07+/-1.56 ng/mL) and in 73% of CAPD patients (mean 4.87+/-1.56 ng/mL). Serum levels of ProGRP were above the cutoff limit (46.0 pg/mL) in 90% of HD patients (mean 107.0+/-59.4 pg/mL) and in 93% of CAPD patients (mean 112.4+/-44.5 pg/mL). Our data indicate that evaluation of renal function is essential when the measurement of these tumor markers is to be applied as one of the diagnostic tools of lung cancer.
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Affiliation(s)
- H Nakahama
- Fifth Department of Internal Medicine, Hyogo College of Medicine, Japan
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