title: Urothelial carcinoma in patients with advanced kidney disease: a 12-year retrospective cohort survey.
abstract: BACKGROUND
  The goal of this study was to compare the clinical and pathological features of urothelial carcinoma (UC) identified in patients with end-stage renal disease (ESRD) and advanced-stage chronic kidney disease (CKD). The predictive value of CKD on patient mortality in these UC patients was also analyzed.
  
  
  METHODS
  From January 1997 to December 2008, 141 patients with pathologically proven UC with stage 4/5 CKD (predialysis) and patients with ESRD receiving long-term dialysis were identified under an institutional review board approval protocol. The medical records and survival outcome of these patients were reviewed.
  
  
  RESULTS
  A total of 141 UC patients with renal diseases (n = 97, 68.8%, of stage 4/5 CKD; n = 44, 31.2%, at dialysis) were enrolled. Patients with stage 4/5 CKD were significantly older, male gender, less anemic and more likely to have higher prevalence of diabetes mellitus (P < 0.05). We noticed a more significant increase in the frequency of high-stage UC (24.7% and 6.8%) and a larger tumor size (50.5% and 27.3%) in patients with stage 4/5 CKD, compared with patients with ESRD (P < 0.05). Old age at the time of dialysis initiation in patients with ESRD [hazard ratio (HR) = 1.121, P = 0.039], male gender (HR = 6.822, P = 0.016) and high-stage tumors (HR = 5.012, P = 0.008) in patients with stage 4/5 CKD were independent predictors of mortality from UC.
  
  
  CONCLUSIONS
  Patients with stage 4/5 CKD had more aggressive histological UC patterns than did patients with ESRD.
authors: Division of Nephrology, Department of Internal Medicine, Chia-yi Christian Hospital, Chia-yi, Taiwan.
authors: Peir-Haur
authors: PH
authors: Hung
authors: Cheng-Huang
authors: CH
authors: Shen
authors: Hung-Bin
authors: HB
authors: Tsai
authors: Chih-Yen
authors: CY
authors: Hsiao
authors: Pei-Chun
authors: PC
authors: Chiang
authors: How-Ran
authors: HR
authors: Guo
authors: Kuan-Yu
authors: KY
authors: Hung
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality / Q000473:pathology; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013624:Taiwan; D014571:Urologic Neoplasms / Q000150:complications* / Q000473:pathology; D019459:Urothelium / Q000473:pathology