Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22912
Title: A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation.
Authors: Ellis, Robert J;Del Vecchio, Sharon J;Gallagher, Kevin M J;Aliano, Danielle N;Barber, Neil;Bolton, Damien M;Chew, Etienne T S;Coombes, Jeff S;Coory, Michael D;Davis, Ian D;Donaldson, James F;Francis, Ross S;Giles, Graham G;Gobe, Glenda C;Hawley, Carmel M;Johnson, David W;Laird, Alexander;Leung, Steve;Malki, Manar;Marco, David J T;McNeill, Alan S;Neale, Rachel E;Ng, Keng L;Phipps, Simon;Stewart, Grant D;White, Victoria M;Wood, Simon T;Jordan, Susan J
Affiliation: Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
Eastern Health, Melbourne, Victoria, Australia
Cancer Council Victoria, Melbourne, Victoria, Australia
Centre for Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia
Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
Queensland University of Technology, Brisbane, Queensland, Australia
School of Psychology, Deakin University, Geelong, Victoria, Australia
Department of Surgery, University of Cambridge, Cambridge, United Kingdom
Addenbrooke's Hospital, Cambridge, United Kingdom
Department of Urology, Western General Hospital, Edinburgh, United Kingdom
University of Edinburgh, Edinburgh, United Kingdom
Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
Urology Department, Frimley Park Hospital, Frimley, United Kingdom
Logan Hospital, Logan, Queensland, Australia
Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
Department of Urology, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
University of Edinburgh, Edinburgh, United Kingdom
Urology Department, Frimley Park Hospital, Frimley, United Kingdom..
Issue Date: 1-Apr-2020
EDate: 2020-04-01
Citation: Journal of the American Society of Nephrology : JASN 2020; online first: 1 April
Abstract: Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed. To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk). Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts. Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22912
DOI: 10.1681/ASN.2019121328
ORCID: 0000-0002-6288-5401
0000-0003-4946-9099
0000-0002-5145-6783
PubMed URL: 32238473
Type: Journal Article
Subjects: Nephrectomy
chronic kidney disease
glomerular filtration rate
kidney cancer
renal cell carcinoma
risk stratification
Appears in Collections:Journal articles

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