title: Patients with urothelial carcinoma have poor renal outcome regardless of whether they receive nephrouretectomy.
abstract: The association between urothelial carcinoma (UC) and subsequent ESRD incidence has not been confirmed. This was a population-based study using claims data from the Taiwan National Health Institutes from 1998 to 2010. The study cohort consisted of 26,017 patients with newly diagnosed UC and no history of ESRD, and the comparison cohort consisted of 208,136 matched enrollees without UC. The incidence of ESRD was ascertained through cross-referencing with a registry for catastrophic illnesses. Cox proportional hazard regression analysis was used to estimate the risk of ESRD associated with UC and UC subtype. A total of 979 patients (3.76%) from the UC group and 1,829 (0.88%) from the comparison group developed ESRD. Multivariable analysis indicated that compared with the comparison group, the hazard ratios (HRs) for ESRD were 7.75 (95% confidence interval [CI]: 6.84 to 8.78) and 3.12 (95% CI: 6.84 to 8.78) in the cohort with upper urinary tract UC (UT-UC) and bladder UC (B-UC), respectively. In addition, there were significantly increased risks for ESRD in UC patients receiving and not receiving nephrouretectomies or aristolochic acids (AA). Moreover, the UC patients receiving segmental ureterectomy and ureteral reimplantation had approximately 1.3-fold and 2.4-fold increased risk for ESRD after control for confounders, respectively. Thus, our data indicate that UT-UC and B-UC independently increased the risk for ESRD in patients after considering about nephrouretectomies or aristolochic acids (AA). In addition, UC patients receiving segmental ureterectomy and ureteral reimplantation had increased risk for ESRD.
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.|Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.affiliation: Department of Tramatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Mu-Chi
authors.initials: MC
authors.lastname: Chung
authors.affiliation: Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D034341:Aristolochic Acids / Q000737:chemistry; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*
chemical_list: D034341:Aristolochic Acids; C000228:aristolochic acid I
keywords: chronic kidney disease; end stage renal disease; nephrouretectomy; urothelial carcinoma