Development of a novel score (RENSAFE) to determine probability of acute kidney injury and renal functional decline post surgery: A multicenter analysis.
Urol Oncol
; 41(12): 487.e15-487.e23, 2023 12.
Article
em En
| MEDLINE
| ID: mdl-37880003
ABSTRACT
OBJECTIVE:
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.METHODS:
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).RESULTS:
AKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (ORâ¯=â¯1.3, Pâ¯=â¯0.02), ASA score (ORâ¯=â¯1.3, P < 0.01), hypertension (ORâ¯=â¯1.6, P < 0.001), R.E.N.A.L. score (ORâ¯=â¯1.2, P < 0.001), preoperative eGFR<60 (ORâ¯=â¯1.8, Pâ¯=â¯0.009), and RN (ORâ¯=â¯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 (ORâ¯=â¯2.2, P < 0.001), but not CKD≥3b (Pâ¯=â¯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%.CONCLUSION:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Renal Crônica
/
Injúria Renal Aguda
/
Neoplasias Renais
Limite:
Humans
/
Male
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article