Miyamoto Yoshihisa, Iwagami Masao, Aso Shotaro, Uda Kazuaki, Fushimi Kiyohide, Hamasaki Yoshifumi, Nangaku Masaomi, Yasunaga Hideo, Doi Kent
Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Health Services Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Japan.
Clin Kidney J. 2022 Jan 13;15(6):1137-1143. doi: 10.1093/ckj/sfac005. eCollection 2022 Jun.
The difference in outcomes of cancer surgery between patients with and without kidney failure with dialysis therapy (KFDT) remains uncertain.
Using 2010-18 data in a national inpatient database in Japan, we identified patients who had undergone resection of colorectal, lung, gastric or breast cancer. We matched selected patient characteristics, type of cancer, surgical procedure and hospital of up to four patients without KFDT to each patient with KFDT. We assessed 30-day mortality and postoperative complications.
Through matching, we identified 2248 patients with KFDT (807 with colorectal, 579 with lung, 500 with gastric and 362 with breast cancer) and 8210 patients without KFDT (2851 with colorectal, 2216 with lung, 1756 with gastric and 1387 with breast cancer). Postoperative complications occurred in a higher proportion of patients with KFDT than of those without KFDT after colorectal {20.3% versus 14.6%; risk difference (RD): 5.7% [95% confidence interval (95% CI) 2.6%-8.8%]}, lung [18.0% versus 12.9%; RD: 5.1% (95% CI 1.6%-8.4%)], gastric [25.0% versus 13.2%; RD: 11.8% (95% CI 7.6%-16.2%)] and breast cancer surgery [7.5% versus 3.5%; RD: 3.9% (95% CI 1.1%-6.9%)]. Patients with KFDT had a higher 30-day mortality than those without KFDT after gastric cancer surgery [1.6% versus 0.3%; RD: 1.3% (95% CI 0.1%-2.3%)]. Heart failure and ischemic heart disease occurred more frequently in patients with KFDT.
Patients with KFDT had higher rates of postoperative complications and 30-day mortality; however, RDs varied between cancer types. The higher rates of postoperative complications in patients with KFDT were mainly attributable to cardiovascular complications.
接受透析治疗的肾衰竭患者与未接受透析治疗的肾衰竭患者在癌症手术结果上的差异仍不明确。
利用日本全国住院患者数据库2010 - 2018年的数据，我们确定了接受结直肠癌、肺癌、胃癌或乳腺癌切除术的患者。我们将最多4名未接受透析治疗的患者的选定患者特征、癌症类型、手术方式和医院与每名接受透析治疗的患者进行匹配。我们评估了30天死亡率和术后并发症。
通过匹配，我们确定了2248名接受透析治疗的患者（807名患有结直肠癌，579名患有肺癌，500名患有胃癌，362名患有乳腺癌）和8210名未接受透析治疗的患者（2851名患有结直肠癌，2216名患有肺癌，1756名患有胃癌，1387名患有乳腺癌）。结直肠癌手术后，接受透析治疗的患者术后并发症发生率高于未接受透析治疗的患者{20.3%对14.6%；风险差异（RD）：5.7%[95%置信区间（95%CI）2.6% - 8.8%]}，肺癌[18.0%对12.9%；RD：5.1%（95%CI 1.6% - 8.4%）]，胃癌[25.0%对13.2%；RD：11.8%（95%CI 7.6% - 16.2%）]和乳腺癌手术[7.5%对3.5%；RD：3.9%（95%CI 1.1% - 6.9%）]。胃癌手术后，接受透析治疗的患者30天死亡率高于未接受透析治疗的患者[1.6%对0.3%；RD：1.3%（95%CI 0.1% - 2.3%）]。心力衰竭和缺血性心脏病在接受透析治疗的患者中更频繁发生。
接受透析治疗的患者术后并发症发生率和30天死亡率更高；然而，风险差异在不同癌症类型之间有所不同。接受透析治疗的患者术后并发症发生率较高主要归因于心血管并发症。
