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Prediction of significant estimated glomerular filtration rate decline after renal unit removal to aid in the clinical choice between radical and partial nephrectomy in patients with a renal mass and normal renal function
Author(s) -
McIntosh Andrew G.,
Parker Daniel C.,
Egleston Brian L.,
Uzzo Robert G.,
Haseebuddin Mohammed,
Joshi Shreyas S.,
Viterbo Rosalia,
Greenberg Richard E.,
Chen David Y. T.,
Smaldone Marc C.,
Kutikov Alexander
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14839
Subject(s) - nomogram , renal function , medicine , nephrectomy , receiver operating characteristic , urology , logistic regression , kidney disease , creatinine , area under the curve , surgery , kidney
Objectives To develop a clinically applicable predictive model to quantitate the risk of estimated glomerular filtration rate (eGFR) decline to ≤45 mL/min/1.73 m 2 after radical nephrectomy (RN) to better inform decisions between RN and partial nephrectomy (PN). Patients and Methods Our prospectively maintained kidney cancer registry was reviewed for patients with a preoperative eGFR >60 mL/min/1.73 m 2 who underwent RN for a localized renal mass. New baseline renal function was indexed. We used multivariable logistic regression to develop a predictive nomogram and evaluated it using receiver‐operating characteristic (ROC) analysis. Decision‐curve analysis was used to assess the net clinical benefit. Results A total of 668 patients met the inclusion criteria, of whom 183 (27%) experienced a decline in eGFR to ≤45 mL/min/1.73 m 2 . On multivariable analysis, increasing age ( P = 0.001), female gender ( P < 0.001), and increasing preoperative creatinine level ( P < 0.001) were associated with functional decline. We constructed a predictive nomogram that included these variables in addition to comorbidities with a known association with kidney disease, but found that a simplified model excluding comorbidities was equally robust (cross‐validated area under the ROC curve was 0.78). Decision‐curve analysis showed the net clinical benefit at probabilities >~11%. Conclusions The decision to perform RN vs PN is multifaceted. We have provided a simple quantitative tool to help identify patients at risk of a postoperative eGFR of ≤45 mL/min/1.73 m 2 , who may be stronger candidates for nephron preservation.