title: Comparison of rates and risk factors for development of anaemia and erythropoiesis-stimulating agent utilization after radical or partial nephrectomy.
abstract: OBJECTIVE
  To examine the incidence of and risk factors for the development of anaemia and erythropoiesis-stimulation agent (ESA) treatment in patients undergoing radical nephrectomy (RN) and partial nephrectomy (PN) because anaemia is a significant cause of morbidity in chronic kidney disease.
  
  
  METHODS
  The study comprised a retrospective review of 905 patients (610 RN/295 PN; mean age, 57.5 years; mean follow-up, 6.4 years) who underwent surgery for renal tumours at two institutions from July 1987 to June 2007. Demographics, disease characteristics and pre- and postoperative (i.e. renal function, metabolic parameters, anaemia and ESA treatment) were recorded. Data were analyzed within subgroups based on treatment (RN vs PN). Multivariate analysis was conducted to determine the risk factors for developing anaemia after surgery.
  
  
  RESULTS
  Tumour size (cm) was significantly larger for RN (RN 7.0 vs PN 3.7; P < 0.001). No significant differences were noted with respect to demographics and preoperative anaemia (RN 16.4% vs PN 18.6%; P = 0.454) and ESA-treatment (RN 0.7% vs PN 1.4%; P = 0.499). After surgery, significantly less de novo anaemia (PN 4.1% vs RN 17.5%; P < 0.001) and ESA utilization (PN 2.7% vs RN 13.4%; P < 0.001) occurred in the PN cohort. Multivariate analysis showed that age ≥60 years (odds ratio, OR, 1.62; P = 0.008), African American ethnicity (OR, 2.30; P < 0.001), smoking (OR, 1.60; P = 0.013), glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) (OR, 4.09; P < 0.001), ≥1+ proteinuria (OR, 2.19; P < 0.03), metabolic acidosis (OR, 4.08; P = 0.007) and RN (OR, 2.58; P < 0.001) were significantly associated with de novo anaemia.
  
  
  CONCLUSIONS
  Patients who underwent RN had a significantly higher prevalence of anaemia and ESA-treatment compared to a well-matched cohort that underwent PN. In addition to RN, age ≥60 years, African American ethnicity, history of smoking, GFR < 60 mL/min/1.73 m(2), proteinuria and metabolic acidosis were associated with developing anaemia.
authors.affiliation: Division of Urology, University of California San Diego Medical Center, San Diego, CA 92093-0987, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Woldrich
authors.forename: Reza
authors.initials: R
authors.lastname: Mehrazin
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Patterson
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors
chemical_list: D006397:Hematinics