RENAL FUNCTION VARIABILITY: A SIMPLE METHOD TO IDENTIFY SUBCLINICAL KIDNEY DISEASE BEFORE NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2018MP28-07 RENAL FUNCTION VARIABILITY: A SIMPLE METHOD TO IDENTIFY SUBCLINICAL KIDNEY DISEASE BEFORE NEPHRECTOMY Andrew Sun, I-Chun Thomas, Calyani Ganesan, Joanna Sylman, Alan Pao, Todd Wagner, James Brooks, Glenn Chertow, and John Leppert Andrew SunAndrew Sun More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Calyani GanesanCalyani Ganesan More articles by this author , Joanna SylmanJoanna Sylman More articles by this author , Alan PaoAlan Pao More articles by this author , Todd WagnerTodd Wagner More articles by this author , James BrooksJames Brooks More articles by this author , Glenn ChertowGlenn Chertow More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.907AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney function variability has been associated with worse renal outcomes for patients with chronic kidney disease (CKD). We sought to determine if variability in preoperative kidney function was associated with development of significant CKD and overall survival following radical and partial nephrectomy in a large integrated health care system. METHODS We identified all patients who underwent radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration (VHA) (n=18,617). We extracted clinical and demographic information using national VHA data, as well as all available outpatient kidney function measurements from 12 months prior to surgery until the end of the study period. We excluded patients with less than 3 preoperative kidney function measurements or a baseline preoperative estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2. Preoperative variability was defined as the coefficient of variation (CV) of the outpatient eGFR measurements. The primary outcome was time to significant CKD (eGFR < 30). The final analytic cohort was stratified by radical nephrectomy (n=8,189) and partial nephrectomy (n=4,082). We visualized time to eGFR < 30 and survival using Kaplan-Meier plots. We fit uni- and multi-variable proportional hazard models controlling for clinical and tumor characteristics. RESULTS In this cohort of 12,271 patients, the median number of outpatient preoperative kidney function measurements was 5 (IQR 4 to 6) and the median preoperative eGFR was 68.8 (IQR 54.2 to 84.6). The mean CV was 0.13 (SD 0.08) and 0.11 (SD 0.07) prior to radical and partial nephrectomy, respectively. The CV was associated time to eGFR < 30 (HR 1.32, 95%CI 1.26 to 1.37). In fully adjusted models, the CV remained independently associated with time to eGFR < 30 (HR 1.05, 95%CI 0.99 to 1.10 after radical; HR 1.24, 95%CI 1.12 to 1.37 after partial) and overall survival (HR 1.28, 95%CI 1.16 to 1.42 after radical; HR 1.12, 95%CI 1.07 to 1.17 after partial). CONCLUSIONS Preoperative kidney function variability can identify subclinical CKD and is associated with renal outcomes and mortality after nephrectomy. Using commonly available data, this simple metric may improve prognostication for patients undergoing kidney cancer surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e358-e359 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Sun More articles by this author I-Chun Thomas More articles by this author Calyani Ganesan More articles by this author Joanna Sylman More articles by this author Alan Pao More articles by this author Todd Wagner More articles by this author James Brooks More articles by this author Glenn Chertow More articles by this author John Leppert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...