Following partial nephrectomy (PN), it is important to prevent any deterioration in estimated glomerular filtration rate (eGFR). At present there are no evidence-based recommendations on when a nephrology consultation should be requested and how to adjust postoperative management when the risk of renal function decline is high.
In an effort to address this void, we used our previously published nomogram to define risk groups for a significant decline in eGFR between 3-15 mo after PN. We used the nomogram-derived probability as the independent variable for the classification and regression tree and identified four risk groups: low (0-10%), intermediate (10-21%), high (21-65%), and very high (65-100%). Overall, 336 (34%), 386 (39%), 243 (24%), and 34 (4%) patients fell in the low, intermediate, high, and very high risk groups, respectively. The rates of significant eGFR decline across the low, intermediate, high, and very high risk groups were 4%, 14%, 29%, and 79%. With the low risk category as a reference, the hazard ratio for eGFR decline was 3.21 (95% confidence interval [CI] 1.83-5.64) for the intermediate, 7.80 (95% CI 4.52-13.48) for the high, and 27.24 (95% CI 13.8-53.8) for the very high risk group (all p < 0.001). These prognostic risk categories can be used to design postoperative follow-up schedules. A multidisciplinary approach can be considered for patients at high and very high risk of eGFR decline. PATIENT SUMMARY: We propose a new stratification system to identify individuals at high risk of a decline in renal function after robotic partial nephrectomy.
European urology oncology. 2019 Jul 30 [Epub ahead of print]
Alberto Martini, Ugo Giovanni Falagario, Shivaram Cumarasamy, Ronney Abaza, Daniel D Eun, Akshay Bhandari, James R Porter, Ashok K Hemal, Ketan K Badani
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: ., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA., Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA., Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA., Swedish Urology Group, Seattle, WA, USA., Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA.