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21st century trends in management of small renal cancers - News-Medical.net PDF Print

By Shreeya Nanda, Senior medwireNews Reporter

A US population-based cohort study reveals a change in the management of small renal masses in the 21st century with rates of nephron-sparing surgery on the rise and a corresponding decrease in the use of radical nephrectomy.

Analysis of the Surveillance, Epidemiology, and End Results (SEER) database showed that between 2001 and 2009, 6664 US patients aged 66 years or older were diagnosed with a primary renal tumour smaller than 4 cm – of these 90.0% were treated surgically.

During the study period, the proportion of patients receiving nephron-sparing surgery, comprising partial nephrectomy and ablation, increased from 21.5% to 49.0%.

By contrast, rates of radical nephrectomy in the same period decreased from 69.0% to 42.5%, with nephron-sparing surgery eclipsing radical nephrectomy in 2009 as the most common treatment for small renal cancers.

The proportion of patients receiving nonsurgical care remained stable between 2001 and 2009, at 9.5% and 8.5%, respectively.

After a median follow-up of 63 months, the 3-year and 5-year overall survival rates were 90% and 81%, respectively, for patients who received nephron-sparing surgery and 83% and 72% for those treated with radical nephrectomy. The corresponding rates in the nonsurgical management group were 73% and 61%.

Multivariate analysis, adjusting for patient and disease characteristics, showed that both nephron-sparing surgery and radical nephrectomy significantly reduced the likelihood of mortality from any cause compared with nonsurgical management, with adjusted hazard ratios (HR) of 0.55 and 0.76, respectively.

However, only nephron-sparing surgery was also significantly associated with a decreased risk of renal cancer-related mortality, with an adjusted HR of 0.47.

Highlighting the low number of cancer-related deaths (4.4 vs 31.8% from any cause), the team notes that the overall survival benefit associated with surgery may “reflect patient selection rather than a direct benefit of surgery.”

Researcher William Huang, from New York University Langone Medical Center in the USA, and colleagues observe in JAMA Surgery: “Although our findings support nonsurgical management as an acceptable treatment option for small kidney tumors in elderly patients or those with limited life expectancy, it appears that nonsurgical management of small kidney cancers remains uncommon and stable over time.”

“It is possible, however, that with heightened awareness of outcomes from studies such as ours, the use of nonsurgical management may increase.”

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2015

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

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21st century trends in management of small renal cancers - News-Medical.net PDF Print

By Shreeya Nanda, Senior medwireNews Reporter

A US population-based cohort study reveals a change in the management of small renal masses in the 21st century with rates of nephron-sparing surgery on the rise and a corresponding decrease in the use of radical nephrectomy.

Analysis of the Surveillance, Epidemiology, and End Results (SEER) database showed that between 2001 and 2009, 6664 US patients aged 66 years or older were diagnosed with a primary renal tumour smaller than 4 cm – of these 90.0% were treated surgically.

During the study period, the proportion of patients receiving nephron-sparing surgery, comprising partial nephrectomy and ablation, increased from 21.5% to 49.0%.

By contrast, rates of radical nephrectomy in the same period decreased from 69.0% to 42.5%, with nephron-sparing surgery eclipsing radical nephrectomy in 2009 as the most common treatment for small renal cancers.

The proportion of patients receiving nonsurgical care remained stable between 2001 and 2009, at 9.5% and 8.5%, respectively.

After a median follow-up of 63 months, the 3-year and 5-year overall survival rates were 90% and 81%, respectively, for patients who received nephron-sparing surgery and 83% and 72% for those treated with radical nephrectomy. The corresponding rates in the nonsurgical management group were 73% and 61%.

Multivariate analysis, adjusting for patient and disease characteristics, showed that both nephron-sparing surgery and radical nephrectomy significantly reduced the likelihood of mortality from any cause compared with nonsurgical management, with adjusted hazard ratios (HR) of 0.55 and 0.76, respectively.

However, only nephron-sparing surgery was also significantly associated with a decreased risk of renal cancer-related mortality, with an adjusted HR of 0.47.

Highlighting the low number of cancer-related deaths (4.4 vs 31.8% from any cause), the team notes that the overall survival benefit associated with surgery may “reflect patient selection rather than a direct benefit of surgery.”

Researcher William Huang, from New York University Langone Medical Center in the USA, and colleagues observe in JAMA Surgery: “Although our findings support nonsurgical management as an acceptable treatment option for small kidney tumors in elderly patients or those with limited life expectancy, it appears that nonsurgical management of small kidney cancers remains uncommon and stable over time.”

“It is possible, however, that with heightened awareness of outcomes from studies such as ours, the use of nonsurgical management may increase.”

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2015

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

...

 
'She understands what it is to have a loved one of dialysis' Raquel to run for ... - WalesOnline PDF Print

A hotel worker whose father was diagnosed with kidney failure when she was a child has decided to raise funds for the charity that supported him.

Raquel Riesgo Franco, from Cardiff, was nine when her father was taken into hospital with high blood pressure and subsequently diagnosed with chronic kidney failure.

He was referred for treatment and required to receive dialysis filtering in hospital three times a week.

Finally, a positive match was found

While waiting for a transplant, he remained on dialysis for five years and was given a home dialysis machine.

Finally, in 2003, he was told a positive donor match had been found and was able to go for the operation that saved his life.

Now Raquel has decided to raise money for the Kidney Wales Foundation by completing an obstacle course called the Gauntlet Games.

RELATED: Brave Summer to take part in third charity fun run

She said: “It will be such a great opportunity to not only raise money for the great work that Kidney Wales do, but also to raise awareness that people can save lives when they donate their organs to people in need – like my father was.”

Raquel, who works for the Cardiff Marriott Hotel, will be joined by her colleagues to complete the race. The team have also chosen Kidney Wales as their charity of the year.

'This is my first time doing anything like this'

She added: “I’m really grateful that the team at the Marriott want to get involved with these games and support Kidney Wales, who make a huge difference to families like mine.

“These fundraising activities give families the opportunity to meet with other people in similar situations and all share the same great experience.

“I recommend anyone of any fitness ability to sign up – this is my first time doing anything like this.”

Kidney Wales chief executive Roy Thomas said: “Raquel understands what it is to have a loved one on dialysis.

RELATED: Dialysis machine for young patients unveiled

“The team at the Marriott are not only taking on the challenge of the Gauntlet Games and raising money for our charity, but the Marriott has adopted Kidney Wales as their charity of the year.”

The event on Saturday, June 6 is aimed at people who are new to obstacle racing and will take place in woodland in the Vale of Glamorgan.

The 5km or 10km routes have a Gladiator theme. For more information and to sign up, visit www.thegauntletgames.co.uk

...

 
'She understands what it is to have a loved one of dialysis' Raquel to run for ... - WalesOnline PDF Print

A hotel worker whose father was diagnosed with kidney failure when she was a child has decided to raise funds for the charity that supported him.

Raquel Riesgo Franco, from Cardiff, was nine when her father was taken into hospital with high blood pressure and subsequently diagnosed with chronic kidney failure.

He was referred for treatment and required to receive dialysis filtering in hospital three times a week.

Finally, a positive match was found

While waiting for a transplant, he remained on dialysis for five years and was given a home dialysis machine.

Finally, in 2003, he was told a positive donor match had been found and was able to go for the operation that saved his life.

Now Raquel has decided to raise money for the Kidney Wales Foundation by completing an obstacle course called the Gauntlet Games.

RELATED: Brave Summer to take part in third charity fun run

She said: “It will be such a great opportunity to not only raise money for the great work that Kidney Wales do, but also to raise awareness that people can save lives when they donate their organs to people in need – like my father was.”

Raquel, who works for the Cardiff Marriott Hotel, will be joined by her colleagues to complete the race. The team have also chosen Kidney Wales as their charity of the year.

'This is my first time doing anything like this'

She added: “I’m really grateful that the team at the Marriott want to get involved with these games and support Kidney Wales, who make a huge difference to families like mine.

“These fundraising activities give families the opportunity to meet with other people in similar situations and all share the same great experience.

“I recommend anyone of any fitness ability to sign up – this is my first time doing anything like this.”

Kidney Wales chief executive Roy Thomas said: “Raquel understands what it is to have a loved one on dialysis.

RELATED: Dialysis machine for young patients unveiled

“The team at the Marriott are not only taking on the challenge of the Gauntlet Games and raising money for our charity, but the Marriott has adopted Kidney Wales as their charity of the year.”

The event on Saturday, June 6 is aimed at people who are new to obstacle racing and will take place in woodland in the Vale of Glamorgan.

The 5km or 10km routes have a Gladiator theme. For more information and to sign up, visit www.thegauntletgames.co.uk

...

 
Measuring kidney health could predict heart disease risk - NephrologyNews.com PDF Print

Simple measures of kidney function and damage may be just as good at predicting who is at risk for heart failure and death from heart attack and stroke as traditional tests of cholesterol levels and blood pressure, new Johns Hopkins Bloomberg School of Public Health-led research suggests.

The researchers say their data, published in the  may 29 issue of Lancet Diabetes and Endocrinology, may help physicians make better decisions about whether patients need lifestyle modifications such as better diets and more exercise or treatments such as statins, medication widely used for cardiovascular disease prevention. 

The researchers note, the information is already widely available for many patients. The most common assessment of kidney function, the estimated glomerular filtration rate, or eGFR, is given an estimated 290 million times every year in the United States. Another key test measures albuminuria, and higher amounts indicate the presence of kidney damage. It is also a fairly common test, particularly in patients with diabetes, hypertension and kidney disease.


Related
NKF survey reveals many Americans know little about their kidneys


“If health care providers have data on kidney damage and kidney function —which they often do — they should be using those data to better understand a patient’s risk of cardiovascular disease,” says study lead author Kunihiro Matsushita, MD, PhD, an assistant scientist in the Bloomberg School’s Department of Epidemiology. “Cholesterol levels and blood pressure tests are good indicators of cardiovascular risk, but they are not perfect. This study tells us we could do even better with information that often times we are already collecting.”

The Chronic Kidney Disease Prognosis Consortium coordinated by Professor Josef Coresh, MD, PhD, and colleagues at the Johns Hopkins Bloomberg School of Public Health analyzed data from 24 studies that included more than 637,000 participants with no history of cardiovascular disease and the results of tests of eGFR and albuminuria. They found that both eGFR levels and albuminuria independently improved prediction of cardiovascular disease in general and particularly heart failure and death from heart attack and stroke, but albuminuria was the stronger predictor. It outperformed cholesterol levels and systolic blood pressure – and even whether someone is a smoker—as a risk factor for heart failure and death from heart attack or stroke.

People with chronic kidney disease are twice as likely to develop cardiovascular disease as those with healthy kidneys and roughly half of them die from it before they reach kidney failure.

Several clinical guidelines already recommend that patients with diabetes, hypertension and the possibility of chronic kidney disease be evaluated for kidney function and kidney damage.

Matsushita says the new data demonstrate that other individuals not covered by the recommendations may also benefit from having their kidneys assessed. For example, he says, the ability to predict cardiovascular risk was particularly robust in black study participants when eGFR and albuminuria were considered.

The biological mechanisms linking kidney disease to cardiovascular disease aren’t well understood, but Matsushita says that poorly functioning kidneys can lead to a fluid overload that may result in heart failure. He says that people with kidney disease tend to not receive certain medications that can reduce heart ailments, such as statins, likely because patients with kidney disease frequently are excluded from clinical trials performed to prove the efficacy of these medicines.

“Estimated Glomerular Filtration Rate and Albuminuria for Prediction of Cardiovascular Outcomes: A Collaborative Meta-Analysis” was written by Kunihiro Matsushita, Josef Coresh, Yingying Sang, John Chalmers, Caroline Fox, Tazeen Jafar, Simerjot K. Jassal, Gijs W. D. Landman, Paul Roderick, Toshimi Sairenchi, Ben Schöttker, Anoop Shankar, Michael Shlipak, Marcello Tonelli, Jonathan Townend, Arjan van Zuilen, Kazumasa Yamagishi, Kentaro Yamashita, Ron Gansevoort, Mark Sarnak, David G. Warnock, Mark Woodward, and Johan Arnlov, for the CKD Prognosis Consortium.

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