OBJECTIVES To analyze baseline symptoms, comorbidities, and treatments in newly diagnosed RCC patients by age group. METHODS Retrospective claims-based analysis was conducted using MarketScan MedStat, a database covering all US census regions, including ≥18 million lives for years 2002-2008. Patients with initial RCC diagnosis in 2005-2007, ≥2 outpatient or ≥1 inpatient RCC claims (ICD9 189.0 or 198.0), continuous health care coverage, and >180 days coverage before diagnosis were included. Patients were followed from diagnosis until health care coverage end or June 30, 2008. Conditions, symptoms, and individual Charlson comorbidities were assessed. Treatment was analyzed using prevalence and time to initiation in patients RESULTS Of 12,253 patients identified, 61.8% were male (mean age, 63 years old) and 51.0% were <65 years old. Overall, pain (59.6%), hypertension (53.7%), anemia (23.2%), diabetes (23.6%), and chronic kidney disease (19.4%) were most common comorbidities reported. Most comorbidities were prevalent in ≥65 years old than <65 years old: notably, cerebrovascular disease (8.7% vs. 3%; P<0.001), acute myocardial infarction (2% vs 0.7%; P<0.001), and chronic renal failure (9.3% vs. 6%; P<0.001). In <65 and ≥65 groups, most commonly used treatments were nephrectomy (53.4% vs. 40.4%; P<.001), intravenous chemotherapy (11.7% vs. 13.3%; P=0.0079) and oral chemotherapy (10.5% vs. 13.3%; P<0.0001), although less than 4% of patients in either group received FDA-approved oral agents sorafenib or sunitinib. For <65 and ≥65 groups, respectively, mean time from RCC diagnosis to: nephrectomy, 25 and 31 days; radiotherapy, 170 and 177 days; intravenous chemotherapy, 154 and 181 days; sorafenib, 220 and 247 days; sunitinib, 221 and 205 days. CONCLUSIONS Baseline comorbidities and symptoms were more common in RCC patients ≥65 years old than those <65 years old. Nephrectomy was used more frequently in patients <65, probably because of comorbidities in older patients. In contrast, systemic treatment was similar in both groups.