Abstract: FR-PO526

Survival Benefit of Nephrologist Follow-Up in Stage IV Cancer Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Ishii, Taisuke, St.Luke's international hospital, Tokyo, Japan
  • Fujimaru, Takuya, Tokyo Medical and Dental University, Tokyo, Japan
  • Nakano, Eriko, St.Luke's international hospital, Tokyo, Japan
  • Komatsu, Yasuhiro, St.Luke's international hospital, Tokyo, Japan
Background

The prevalence of chronic kidney disease (CKD) is increasing among cancer patients. And CKD affects mortality of the patients with stage IV solid cancer. Several studies have shown that nephrologist follow-up resulted in improving survival of CKD patients. However, it is not clear whether nephrologist co-management could improve mortality.

Methods

In this single-center, retrospective cohort study, we collected data from all patients who were newly diagnosed as stage IV solid cancer with CKD from January 2007 to December 2016. The follow-up period lasted until April 2017. CKD was defined as eGFR ≤ 60 ml/min/1.73m2 both at the time of cancer diagnosis and 90 days before the diagnosis. Nephrologist follow-up was defined as visit to nephrologist after diagnosed with the cancer. The primary endpoint was all-cause mortality. The secondary endpoint was cancer-specific mortality. Log-rank test and Cox proportional hazard analysis were used for analysis.

Results

192 patients met inclusion criteria (age 78±9, 61.5% of males). CKD stage G3, G4, and G5 were 82.3%, 14.1%, and 3.6% respectively. In these patients, nephrologist follow-up were 24.7%, 48.1%, and 57.1%, respectively. During follow-up (median 134 days, IQR 46-415 days), 145 patients (75.5%) died. On Kaplan-Meier survival analysis, patients who visited nephrologist showed significantly better survival compared to those who did not visit at all (log-rank test, p < 0.001). After adjusting for age, gender, type of cancer, anticancer therapy, history of cardiovascular disease, baseline eGFR, serum WBC, CRP, proteinuria and ECOG Performance Status, nephrologist follow-up remained significant association with lower all-cause mortality and cancer specific mortality (HR 0.51, 95% CI 0.32-0.81 and HR 0.52, 95% CI 0.32-0.83, respectively).

Conclusion

Nephrologist follow-up was associated with lower risk of deaths in stage IV cancer patients with CKD.