Renal Morbidity Following Kidney Cancer Surgery

描述（由申请人提供）：肾癌手术导致的肾肿块显著丢失的影响尚不完全清楚。大型临床研究表明，肾功能丧失与住院、心血管事件和全因死亡率增加有关。肾细胞癌（RCC）患者往往年龄较大，通常伴有基线肾功能较低的合并症，并且可能对肾癌手术后肾功能的进一步丧失特别敏感。因此，非常有必要确定RCC的替代手术入路对肾功能和下游临床结果的比较有效性。这个奖励期的目标是让Leppert博士在泌尿系统健康服务研究和RCC临床结果的专业知识方面实现完全的独立。他将通过斯坦福大学流行病学研究生课程的临床研究课程以及该项目的具体目标接受广泛的培训。本研究的主要目的是确定肾癌手术对肾功能的影响，以及与慢性肾脏疾病（CKD）相关的预后，如终末期肾脏疾病（ESRD）、心血管事件、住院和死亡率。该项目的具体目标是：1)在退伍军人事务部（VA）医疗保健系统内建立一个接受肾癌手术的人的电子数据登记处；2)描述由于特定类型的肾癌手术而导致的肾功能变化；3)将接受的肾癌手术类型和术后肾功能与ESRD风险、CKD相关条件、心血管事件、住院治疗、治疗和治疗之间的联系起来。以及退伍军人医疗保健系统中RCC患者的全因死亡率最终，比较这些手术策略可以提供机会，以改善对诊断为肾细胞癌的患者的护理。

DESCRIPTION (provided by applicant): The impact of significant loss of renal mass resultant from kidney cancer surgery is not fully known. Large clinical studies demonstrate that loss of kidney function correlates with an increased incidence of hospitalizations, cardiovascular events, and all-cause mortality. Patients with renal cell carcinoma (RCC) tend to be older, often have co-morbid conditions associated with lower baseline kidney function, and may be particularly sensitive to further loss of kidney function following kidney cancer surgery. Hence, there is a great need to determine the comparative effectiveness of alternative surgical approaches for RCC on kidney function and downstream clinical outcomes. The goal of this award period is for Dr. Leppert to achieve complete independence as an investigator in urologic health services research and expertise in RCC clinical outcomes. He will receive extensive training through the Clinical Research Track in the Graduate Program in Epidemiology at Stanford University, and through the specific aims of the project. The broad objective of this study is to determine the effect of kidney cancer surgery on kidney function and outcomes associated with chronic kidney disease (CKD) such as end-stage renal disease (ESRD), cardiovascular events, hospitalizations, and mortality. The specific aims of the project are to 1) establish an electronic data registry of persons that underwent kidney cancer surgery within the Veterans Affairs (VA) health care system, 2) characterize the change of kidney function due to specific types of kidney cancer surgery, and 3) to correlate the type of kidney cancer surgery received and post-operative kidney function with the risk of ESRD, conditions associated with CKD, cardiovascular events, hospitalizations, and all-cause mortality among RCC patients in the VA health care system. Ultimately, comparing these surgical strategies can provide opportunities to improve care for patients diagnosed with RCC. PUBLIC HEALTH RELEVANCE: The impact of kidney cancer surgery on chronic kidney disease and its associated clinical outcomes is not fully known. Comparing the effect of kidney cancer surgery on kidney function will help inform treatment decisions and provide opportunities to improve care and clinical outcomes for patients diagnosed with kidney cancer.