EAU 2019: Development and Validation of a Novel Scoring Index CART to Predict Renal Functional Decline Post Partial Nephrectomy

Barcelona, Spain (UroToday.com) Surgical intervention on kidneys significantly impacts on renal functional outcomes. This is even more pronounced in patients with pre-existing chronic kidney disease. Prediction of renal functional deterioration after partial nephrectomy crucial. Ithaar Derweesh and colleagues utilized pre-operative patient demographics, C-reactive protein, and tumor size to design and validate a novel scoring index to predict functional decline after partial nephrectomy.

A multi-institutional dataset was utilized for analysis and validation of patients undergoing partial nephrectomy. Multivariable analysis was carried out for potential variables associated with development of de-novo post-operative chronic kidney disease (CKD) stage IIIB at last follow-up.

Authors analyzed a total of 924 patients. Factors on Multivariable analysis associated with increased risk of development of eGFR<45 included age >65, African-American race, C-reactive protein level >0.5mg/dL, and tumor size >4 cm. For CART (C-reactive protein, Age, Race, Tumor size) score, the following values were assigned: age (≤65=1, age >65=3), race (non-African-American=1, African-American=2), tumor size (≤4=1, >4cm=2), and CRP (≤0.5mg/dL=1, >0.5mg/dL=4). Analysis demonstrated 2.6% of patients with a low score had de novo eGFR<45 postoperatively, while 35% of patients with a high score had de novo eGFR<45.

Dr. Derweesh concluded that CART score represents a novel composite score that significantly predicts the development of eGFR<45 after surgery. This scoring system may provide adjunctive information to inform patient counseling and clinical decision making, as well as an impetus to improve outcomes in at-risk patient subgroups.

Presented by: Ithaar H. Derweesh, MD, Urologic Oncologist, Professor of Urology and Radiology, UC San Diego Health, San Diego California

Written by: Ekaterina Laukhtina, medical student, Institute for Urology and Reproductive Health, Sechenov University at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain from March 15-19, 2019.