How often are patients with diabetes or hypertension being treated with partial nephrectomy for renal cell carcinoma? A population-based analysis

OBJECTIVE To determine partial nephrectomy (PN) use in patients at risk of chronic kidney disease (CKD), such as those with diabetes mellitus (DM) and hypertension (HTN). PATIENTS AND METHODS We conducted a national, population-based, retrospective, observational study using the Canadian Institute for Health Information Discharge Abstract Database. We included all patients treated surgically for renal cell carcinoma from 1 April 1998 to 31 March 2008. Patients with DM and HTN were identified using specific diagnosis codes. The proportions of patients treated with PN were compared in patients with and without DM and HTN using multivariable logistic regression adjusting for covariates. RESULTS A total of 24 579 patients were treated for a renal mass; of these, 4292 (17.5%) underwent PN. In our sample, 5613 (22.8%) patients were identified as having HTN, and 2738 (11.1%) were identified as having DM. PN was used in 17.3% of patients with HTN compared to 17.5% of those without HTN, whereas, in patients with DM, PN was used in 18.6% compared to 17.3% of patients without DM. After adjusting for covariates, neither HTN, nor DM were found to be independently associated with increased PN use (odds ratio, 1.07; 95% CI, 0.98-1.16 and odds ratio, 1.08; 95% CI, 0.96-1.20, respectively). CONCLUSIONS In this contemporary national analysis, PN appears to be underutilized in DM and HTN, despite their known relationship with chronic renal failure. Further studies are needed to elucidate the specific factors contributing to PN underutilization in these susceptible patients.