New Baseline Renal Function after Radical or Partial Nephrectomy: A Simple and Accurate Predictive Model

No AccessJournal of UrologyAdult Urology1 May 2021New Baseline Renal Function after Radical or Partial Nephrectomy: A Simple and Accurate Predictive ModelThis article is commented on by the following:Editorial CommentEditorial Comment Diego Aguilar Palacios, Brigid Wilson, Mustafa Ascha, Rebecca A. Campbell, Sunah Song, Molly E. DeWitt-Foy, Steven C. Campbell, and Robert Abouassaly Diego Aguilar PalaciosDiego Aguilar Palacios *Correspondence: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195 telephone: 216-444-5595; FAX: 216-636-0770; E-mail Address: [email protected] http://orcid.org/0000-0002-9523-3426 Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author , Brigid WilsonBrigid Wilson Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio More articles by this author , Mustafa AschaMustafa Ascha Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio Financial and/or other relationship with Flatiron Health, Inc. and the Roche Group. More articles by this author , Rebecca A. CampbellRebecca A. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author , Sunah SongSunah Song Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio More articles by this author , Molly E. DeWitt-FoyMolly E. DeWitt-Foy Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author , Steven C. CampbellSteven C. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author , and Robert AbouassalyRobert Abouassaly Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001549AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Preoperative estimation of new baseline glomerular filtration rate after partial nephrectomy or radical nephrectomy for renal cell carcinoma has important clinical implications. However, current predictive models are either complex or lack external validity. We aimed to develop and validate a simple equation to estimate postoperative new baseline glomerular filtration rate. Materials and Methods: For development and internal validation of the equation, a cohort of 7,860 patients with renal cell carcinoma undergoing partial nephrectomy/radical nephrectomy (2005–2015) at the Veterans Affairs National Health System was analyzed. Based on preliminary analysis of 94,327 first-year postoperative glomerular filtration rate measurements, new baseline glomerular filtration rate was defined as the final glomerular filtration rate within 3 to 12 months after surgery. Multivariable linear regression analyses were applied to develop the equation using two-thirds of the renal cell carcinoma Veterans Administration cohort. The simplest model with the highest coefficient of determination (R2) was selected and tested. This model was then internally validated in the remaining third of the renal cell carcinoma Veterans Administration cohort. Correlation/bias/accuracy/precision of equation were examined. For external validation, a similar cohort of 3,012 patients with renal cell carcinoma from an outside tertiary care center (renal cell carcinoma-Cleveland Clinic) was independently analyzed. Results: New baseline glomerular filtration rate (in ml/minute/1.73 m2) can be estimated with the following simplified equation: new baseline glomerular filtration rate = 35 + preoperative glomerular filtration rate (× 0.65) – 18 (if radical nephrectomy) – age (× 0.25) + 3 (if tumor size >7 cm) – 2 (if diabetes). Correlation/bias/accuracy/precision were 0.82/0.00/83/−7.5–8.4 and 0.82/−0.52/82/−8.6–8.0 in the internal/external validation cohorts, respectively. Additionally, the area under the curve (95% confidence interval) to discriminate postoperative new baseline glomerular filtration rate ≥45 ml/minute/1.73 m2 from receiver operating characteristic analyses were 0.90 (0.88, 0.91) and 0.90 (0.89, 0.91) in the internal/external validation cohorts, respectively. Conclusions: Our study provides a validated equation to accurately predict postoperative new baseline glomerular filtration rate in patients being considered for radical nephrectomy or partial nephrectomy that can be easily implemented in daily clinical practice. REFERENCES 1. : Malignant renal tumors. In: Campbell-Walsh Urology, 11th ed. Edited by . New York: Elsevier, 2016. Google Scholar 2. : Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol 2016; 196: 989. Link, Google Scholar 3. : Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate. Eur Urol 2015; 68: 996. Google Scholar 4. : Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery. BJU Int 2018; 121: 93. Google Scholar 5. : European Association of Urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 2019; 75: 799. 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Google Scholar Supported by Merit Pilot Award No. PPO 17-216 and Veterans Administration grant. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyFeb 24, 2021, 12:00:00 AMEditorial CommentJournal of UrologyFeb 24, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 5May 2021Page: 1310-1320 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsglomerular filtration ratenephrectomykidney neoplasmsMetricsAuthor Information Diego Aguilar Palacios Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio *Correspondence: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195 telephone: 216-444-5595; FAX: 216-636-0770; E-mail Address: [email protected] More articles by this author Brigid Wilson Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio More articles by this author Mustafa Ascha Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio Financial and/or other relationship with Flatiron Health, Inc. and the Roche Group. More articles by this author Rebecca A. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Sunah Song Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio More articles by this author Molly E. DeWitt-Foy Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Steven C. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio More articles by this author Robert Abouassaly Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio More articles by this author Expand All Supported by Merit Pilot Award No. PPO 17-216 and Veterans Administration grant. Advertisement Loading ...