University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Radiation Epidemiology Team, CESP, Villejuif, France.
University of Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Sud, Inserm, Clinical Epidemiology team, CESP, Villejuif, France.
Clin J Am Soc Nephrol. 2020 Apr 7;15(4):484-492. doi: 10.2215/CJN.10230819. Epub 2020 Mar 6.
Cancer survival is improving along with an increase in the potential for adverse kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of kidney failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and kidney transplantation access.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used the French Renal Epidemiology and Information Network registry to identify patients with kidney failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer-related kidney failure, respectively. The main study outcomes were death and kidney transplantation. After matching cases to two to ten controls (=11,678) with other kidney failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy.
The mean age- and sex-adjusted incidence of nephrotoxin-related kidney failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer-related kidney failure; they increased significantly by 5% and 2% annually, respectively, during 2006-2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related kidney failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related kidney failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls.
Cancer-related kidney failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to kidney transplant remains limited.
随着抗肿瘤治疗或肾切除术导致的潜在不良肾脏影响的增加，癌症患者的生存率得到了提高。我们旨在描述抗肿瘤治疗相关和尿路上皮癌相关的肾脏衰竭的发病率的最新趋势，并评估患者的生存和肾脏移植机会。
我们使用法国肾脏流行病学和信息网络登记处，从 2003 年到 2015 年，确定与抗肿瘤治疗或尿路上皮癌相关的肾脏衰竭患者。我们分别确定了 287 例和 1157 例与肾毒性药物和尿路上皮癌相关的肾脏衰竭病例。主要研究结果是死亡和肾脏移植。在匹配病例与其他原因导致的肾脏衰竭患者（年龄、性别、透析开始年份和糖尿病状态相同）2 到 10 个对照（=11678 例）后，我们分别为有和无活动性恶性肿瘤的患者估计了每个结局的亚分布风险比（SHR）。
经年龄和性别调整后的肾毒性相关肾脏衰竭的发生率为每百万居民 0.43（95%CI，0.38 至 0.49），尿路上皮癌相关肾脏衰竭的发生率为 1.80（95%CI，1.68 至 1.90）；在 2006-2015 年期间，这两种情况的发生率每年分别显著增加 5%和 2%。与匹配的对照组相比，有肾毒性相关肾脏衰竭的患者的死亡率，经年龄、性别和合并症调整后的 SHR 分别为 4.2（95%CI，3.2 至 5.5）和 1.4（95%CI，1.0 至 2.0），有或无活动性恶性肿瘤的患者分别为 2.0（95%CI，1.7 至 2.2）和 1.1（95%CI，0.9 至 1.2）；尿路上皮癌患者的 SHR 分别为 2.0（95%CI，1.7 至 2.2）和 1.1（95%CI，0.9 至 1.2）。与肾毒性相关的肾脏衰竭患者的等待移植 SHR 分别为 0.19（95%CI，0.11 至 0.32）和 0.62（95%CI，0.43 至 0.88），尿路上皮癌患者的 SHR 分别为 0.28（95%CI，0.21 至 0.37）和 0.47（95%CI，0.36 至 0.60）。一旦进入等待名单，病例和对照组之间的移植机会没有显著差异。
与癌症相关的肾脏衰竭正在缓慢但稳定地增加。在开始透析时没有活动性恶性肿瘤的患者的死亡率似乎没有增加，但他们获得肾脏移植的机会仍然有限。
