Prediction of Significant Estimated Glomerular Filtration Rate Decline Following Renal Unit Removal to Aid in the Clinical Choice between Radical and Partial Nephrectomy in Patients with Renal Mass and Normal Renal Function.

To develop a clinically actionable predictive model to quantitate the risk of estimated glomerular filtration rate decline to ≤45 ml/min/1.73m2 following radical nephrectomy in order to better inform decisions between radical and partial nephrectomy.

Our prospectively maintained kidney cancer registry was reviewed for patients with pre-operative estimated glomerular filtration rate > 60 ml/min/1.73m2 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.

668 patients met inclusion criteria. 183 patients (27%) experienced estimated glomerular filtration rate decline to ≤ 45 ml/min/1.73m2 . On multivariable analysis, increasing age (p=0.001), female gender (p<0.001), and increasing pre-operative creatinine (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 receiver operating curve was 0.78). Decision curve analysis demonstrated the net-clinical benefit at probabilities >~11%.

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/1.73m2 who may be stronger candidates for nephron preservation. This article is protected by copyright. All rights reserved.

BJU international. 2019 May 30 [Epub ahead of print]

A G McIntosh, D C Parker, B L Egleston, R G Uzzo, H Haseebuddin, S S Joshi, R Viterbo, R E Greenberg, D Y T Chen, M C Smaldone

Fox Chase Cancer Center, Philadelphia , PA, USA., The University of Oklahoma Health Sciences, Center & The Stephenson Cancer Center, Oklahoma City, OK, USA., Frederick Urology Associates, Frederick, MD, USA.