Pd33-01 Accurate and Simple Prediction of New Baseline Renal Function After Partial Nephrectomy

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD33)1 May 2024PD33-01 ACCURATE AND SIMPLE PREDICTION OF NEW BASELINE RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY Nityam Rathi, Worapat Attawettayanon, Akira Kazama, Yosuke Yasuda, Carlos Munoz-Lopez, Kieran Lewis, Eran Maina, Andrew Wood, Diego Aguilar Palacios, Jianbo Li, Nour Abdallah, Christopher J. Weight, Mohamed Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, and Steven C. Campbell Nityam RathiNityam Rathi , Worapat AttawettayanonWorapat Attawettayanon , Akira KazamaAkira Kazama , Yosuke YasudaYosuke Yasuda , Carlos Munoz-LopezCarlos Munoz-Lopez , Kieran LewisKieran Lewis , Eran MainaEran Maina , Andrew WoodAndrew Wood , Diego Aguilar PalaciosDiego Aguilar Palacios , Jianbo LiJianbo Li , Nour AbdallahNour Abdallah , Christopher J. WeightChristopher J. Weight , Mohamed EltemamyMohamed Eltemamy , Venkatesh KrishnamurthiVenkatesh Krishnamurthi , Robert AbouassalyRobert Abouassaly , and Steven C. CampbellSteven C. Campbell View All Author Informationhttps://doi.org/10.1097/01.JU.0001008912.25331.d7.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is generally preferred for localized renal tumors due to strong functional outcomes. Accurate prediction of new baseline glomerular filtration rate (NBGFR) after PN may facilitate preoperative counseling because NBGFR may affect long-term survival, particularly for patients with preoperative chronic kidney disease. Methods for predicting parenchymal volume preservation, and by extension NBGFR, have been proposed, including those based on contact surface area (CSA) or direct measurement of tissue likely to be excised/devascularized during PN. We previously reported that presuming 89% of global GFR preservation (the median value saved from previous, independent analyses) is as accurate as the more subjective/labor intensive CSA and direct measurement approaches. More recently, several promising complex, multivariate predictive algorithms have been published, which typically include tumor, patient, and surgical factors. In this study, we compare our conceptually simple approach, which presumes that an even 90% of the global GFR is saved with each PN, to these sophisticated algorithms (Figure 1A). METHODS: In total, 631 patients with bilateral kidneys who underwent PN at the Cleveland Clinic (2012-14) with available preoperative/postoperative GFR were analyzed. NBGFR was defined as the final GFR 3-12 months post-PN. Predictive accuracies were assessed with correlation coefficients (r) and mean squared errors. The relationship between preserved parenchymal volume and renal function was examined using volumetric analysis. RESULTS: Our conceptually simple approach had equivalent r values when compared to the complex, multivariable models, and had the lowest degree of error when predicting NBGFR post-PN (Figure 1B-E). The median global renal parenchymal volume preserved after PN was 93%, as assessed by software-derived parenchymal volume analysis (Figure 1F-H), and the median renal function preserved was 89%. CONCLUSIONS: Our simple formula performs equally well as complex algorithms when predicting NBGFR after PN. Strong anchoring by preoperative GFR and minimal functional/parenchymal volume loss (≈10%) with the typical PN likely account for these observations. This practical formula can facilitate counseling about anticipated postoperative functional outcomes after PN. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e709 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nityam Rathi More articles by this author Worapat Attawettayanon More articles by this author Akira Kazama More articles by this author Yosuke Yasuda More articles by this author Carlos Munoz-Lopez More articles by this author Kieran Lewis More articles by this author Eran Maina More articles by this author Andrew Wood More articles by this author Diego Aguilar Palacios More articles by this author Jianbo Li More articles by this author Nour Abdallah More articles by this author Christopher J. Weight More articles by this author Mohamed Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Steven C. Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...