MP84-02 DIFFERING KIDNEY FUNCTION OUTCOMES FOLLOWING KIDNEY CANCER SURGERY IN THE VETERANS HEALTH ADMINISTRATION

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy VII1 Apr 2015MP84-02 DIFFERING KIDNEY FUNCTION OUTCOMES FOLLOWING KIDNEY CANCER SURGERY IN THE VETERANS HEALTH ADMINISTRATION Remy Lamberts, I-Chun Thomas, Benjamin Chung, Geoffrey Sonn, Alice Fan, Sandy Srinivas, Todd Wagner, Glen Chertow, James Brooks, and John Leppert Remy LambertsRemy Lamberts More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Geoffrey SonnGeoffrey Sonn More articles by this author , Alice FanAlice Fan More articles by this author , Sandy SrinivasSandy Srinivas More articles by this author , Todd WagnerTodd Wagner More articles by this author , Glen ChertowGlen Chertow More articles by this author , James BrooksJames Brooks More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Veterans Health Administration (VHA) is the largest integrated national health care system in the US. The VHA has a standardized electronic medical record, including measures of vital signs, laboratory values, and cancer specific data. Users of the VHA diagnosed with kidney cancer tend to be older, have more comorbid conditions, and may be more sensitive to changes in kidney function following kidney cancer surgery. We sought to characterize the change in kidney function across a national contemporary cohort following radical (RN) or partial nephrectomy (PN). METHODS We created a national cohort of patients undergoing RN or PN in the VHA using procedure codes from 2000-2013. We then extracted tumor specific data for patients with entries in the VA Oncology data (CDW) and all measures of kidney function from the laboratory data (DSS). We characterized pre-operative kidney function using the most recent measure, an average of the values over 12 months prior to surgery, and imputed the kidney function on the day of surgery using generalized linear regression. We characterized post-operative kidney function using all available measurements. We imputed kidney function at specific time points to estimate the magnitude of the difference in kidney function between the two surgical approaches. Finally, we fit time to event and proportional hazards models to test the association with radical nephrectomy and the outcome of significant chronic kidney disease (eGFR<30 or claims for ESRD or dialysis) for patients with normal or near normal preoperative kidney function (eGFR >=45). RESULTS We identified a cohort of 9278 patients that underwent kidney cancer surgery with either RN (n=6151) or PN (n=3127). The vast majority of patients had multiple pre- (median 15) and post-operative (median 20) serum measurements of creatinine identified in the VHA. Mean serum pre-operative creatinine values were similar (1.09 vs. 1.1). However, eGFR was higher among patients treated with RN. A contour plot of the 153,470 post-operative eGFR measurements following kidney cancer surgery is shown in the figure. CONCLUSIONS The VHA provides opportunity to measure the change in kidney function following kidney cancer surgery in a national health care system. Integrated health care data can facilitate comparative effectiveness studies with long-term data. PN preserves renal function in an predominantly male, comorbid population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1058 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Remy Lamberts More articles by this author I-Chun Thomas More articles by this author Benjamin Chung More articles by this author Geoffrey Sonn More articles by this author Alice Fan More articles by this author Sandy Srinivas More articles by this author Todd Wagner More articles by this author Glen Chertow More articles by this author James Brooks More articles by this author John Leppert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...