To create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer.
Primary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m2), through stepwise logistic regression. Secondary outcomes include elucidation of the relationship between AKI and de novo CKD≥3a (<60 ml/min/1.73m2). Accuracy was tested with receiver operator characteristic area under the curve (AUC).
AKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (OR = 1.3, P = 0.02), ASA score (OR = 1.3, P < 0.01), hypertension (OR = 1.6, P < 0.001), R.E.N.A.L. score (OR = 1.2, P < 0.001), preoperative eGFR<60 (OR = 1.8, P = 0.009), and RN (OR = 10.4, P < 0.0001) as predictors for AKI. Age (OR 1.0, P < 0.001), diabetes mellitus (OR 2.5, P < 0.001), preoperative eGFR <60 (OR 3.6, P < 0.001) and RN (OR 2.2, P < 0.01) were predictors for CKD≥3b. AUC for RENSAFE AKI was 0.80 and 0.76 for CKD≥3b. AKI was predictive for CKD≥3a (OR = 2.2, P < 0.001), but not CKD≥3b (P = 0.1). Using 21% threshold probability for AKI achieved sensitivity: 80.3%, specificity: 61.7% and negative predictive value (NPV): 88.1%. Using 8% cutoff for CKD≥3b achieved sensitivity: 75%, specificity: 65.7%, and NPV: 96%.
RENSAFE models utilizing perioperative variables that can predict AKI and CKD may help guide shared decision making. Impact of postsurgical AKI was limited to less severe CKD (eGFR<60 ml/min 71.73m2). Confirmatory studies are requisite.
Urologic oncology. 2023 Oct 23 [Epub ahead of print]
Cesare Saitta, Jonathan A Afari, Riccardo Autorino, Umberto Capitanio, Francesco Porpiglia, Daniele Amparore, Federico Piramide, Clara Cerrato, Margaret F Meagher, Sabrina L Noyes, Savio D Pandolfo, Nicolò M Buffi, Alessandro Larcher, Kevin Hakimi, Mimi V Nguyen, Dhruv Puri, Pietro Diana, Vittorio Fasulo, Alberto Saita, Giovanni Lughezzani, Paolo Casale, Alessandro Antonelli, Francesco Montorsi, Brian R Lane, Ithaar H Derweesh
University of California: San Diego Health System, San Diego, CA; Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy., University of California: San Diego Health System, San Diego, CA., Division of Urology, VCU Health, Richmond, VA., Department of Urology, San Raffaele Scientific Institute, Milan, Italy., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy., University of California: San Diego Health System, San Diego, CA; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Spectrum Health, Grand Rapids, Michigan State University College of Human Medicine, Grand Rapids, MI., Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy., Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., University of California: San Diego Health System, San Diego, CA. Electronic address: .