PD49-11 NEPHROLOGY REFERRAL PRACTICES SURROUNDING RENAL CANCER SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (PD49)1 Apr 2020PD49-11 NEPHROLOGY REFERRAL PRACTICES SURROUNDING RENAL CANCER SURGERY Julia Wainger*, Joseph Cheaib, Hiten Patel, Mitchell Huang, Michael Biles, Meredith Metcalf, Joseph Canner, Michael Johnson, Mohamad Allaf, and Phillip Pierorazio Julia Wainger*Julia Wainger* More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Hiten PatelHiten Patel More articles by this author , Mitchell HuangMitchell Huang More articles by this author , Michael BilesMichael Biles More articles by this author , Meredith MetcalfMeredith Metcalf More articles by this author , Joseph CannerJoseph Canner More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000943.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic kidney disease (CKD) is a sequela of renal surgery. Data are limited describing nephrology referral for at-risk patients per 2017 American Urologic Association guidelines. We examined nephrology referral rates amongst renal cancer nephrectomy patients to assess referral predictors and study associations of nephrology referral and survival. METHODS: We obtained data from the SEER-Medicare database for patients ≥66 years old who received nephrectomies for malignancy from 1999-2014 (N=25,641). Referral data were based on nephrology claims. We identified if and when patients were referred by CKD disease status and surgery type, used logistic regression to identify associated patient factors and used a Cox proportional hazard regression model to assess associations with survival. Logistic regression and survival analyses were conducted for cases from 2004-2014 with available comorbidity data (N=16,612). RESULTS: Of 25,641 patients from 1999-2014, 16.3% had pre-operative CKD and 43.4% of patients developed post-operative CKD. Of post-operative CKD patients, 4.8% were referred pre-operatively and 50.2% post-operatively. Figure 1 shows referrals by CKD status and surgery type. Stage III disease (OR: 1.27, CI: 1.10-1.48), higher Charlson Comorbidity Index scores (OR: 1.70, 95% CI: 1.40-2.05), and all stages of pre-operative CKD diagnosis, peaking with Stage 4 disease, (OR: 17.4, 95% CI: 8.72-34.74) were associated with pre-operative referral. For post-operative CKD patients, post-operative referrals by twelve months were associated with diabetes (OR: 1.35, 95% CI: 1.17-1.56), radical nephrectomy (OR: 1.80, 95% CI: 1.43-2.26), and CKD stage at 12 months, with peak odds of nephrology referral associated with stage 4 CKD (OR: 21.84, 95% CI: 12.1-39.5). There was no survival difference (HR= 0.97, 95% CI: 0.88-1.08) for patients with pre-operative referral or post-operative referral by twelve months (HR: 1.04, 95% CI: 0.96-1.13). CONCLUSIONS: Few renal cancer patients at risk for CKD progression or development present with an established nephrologist or receive pre-operative referral, suggesting missed opportunities to refer high risk patients. Pre-operative referral does not appear to improve survival; however, referred patients may represent a higher risk subset, and other patients who may benefit appear under-referred. Source of Funding: Funding for the Predoctoral Clinical Research Training Program is provided by the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Johns Hopkins Institute for Clinical and Translational Research (ICTR) by way of a Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1005-e1005 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Wainger* More articles by this author Joseph Cheaib More articles by this author Hiten Patel More articles by this author Mitchell Huang More articles by this author Michael Biles More articles by this author Meredith Metcalf More articles by this author Joseph Canner More articles by this author Michael Johnson More articles by this author Mohamad Allaf More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...