Re: 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
- Resource Type
- Authors
- Andrew G, McIntosh; Daniel C, Parker; Brian L, Egleston; Robert G, Uzzo; Mohammed, Haseebuddin; Shreyas S, Joshi; Rosalia, Viterbo; Richard E, Greenberg; David Y T, Chen; Marc C, Smaldone; Alexander, Kutikov
- Source
- BJU Int
Journal of urology, 204(1). Elsevier Inc.
- Subject
- Adult
Male
medicine.medical_specialty
Urology
medicine.medical_treatment
Renal function
Kidney
Nephrectomy
Article
Normal renal function
Young Adult
Renal mass
Medicine
Humans
In patient
Renal Insufficiency, Chronic
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Middle Aged
Kidney Neoplasms
Female
business
Glomerular Filtration Rate
- Language
- English
- ISSN
- 0022-5347
OBJECTIVES: To develop a clinically actionable predictive model to quantitate the risk of estimated glomerular filtration rate decline to ≤ 45 ml/min/1.73m(2) following radical nephrectomy in order to better inform decisions between radical and partial nephrectomy. PATIENTS AND METHODS: Our prospectively maintained kidney cancer registry was reviewed for patients with pre-operative estimated glomerular filtration rate > 60 ml/min/1.73m(2) who underwent radical nephrectomy for a localized renal mass. New baseline renal function was indexed. We used multivariable logistic regression to develop a predictive nomogram and evaluated it utilizing receiver operating characteristic analysis. Decision curve analysis assessed the net clinical benefit. RESULTS: 668 patients met inclusion criteria. 183 patients (27%) experienced estimated glomerular filtration rate decline to ≤ 45 ml/min/1.73m(2). On multivariable analysis, increasing age (p=0.001), female gender (p~11%. CONCLUSIONS: The decision to perform radical vs. partial nephrectomy is multifaceted. We provide a simple quantitative tool to help identify patients at risk of a post-operative eGFR of ≤ 45 ml/min/1.73m(2) who may be stronger candidates for nephron preservation.