Model Predicts Kidney Failure Risk After Nephrectomy

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A validated, six-item equation performs well in predicting the 5-year risk of kidney failure in patients undergoing surgery for localized kidney cancer, according to a study in the American Journal of Kidney Diseases.

The model was developed in a population-based cohort of 1026 adults in Manitoba, Canada, who underwent partial or radical nephrectomy for non-metastatic kidney cancer from 2004 through 2016. All patients underwent at least one measurement of estimated glomerular filtration rate (eGFR) both before and after surgery. Models were created to identify factors associated with the 5-year risk of incident kidney failure, defined as dialysis, transplantation, or eGFR less than 15 mL/min/1.73 m2.

The resulting Kidney Cancer Risk Equation (KCRE) comprised six readily accessible variables: age, sex, eGFR, type of nephrectomy, diabetes, and urine albumin-to-creatinine ratio. In the development cohort, the equation showed good predictive performance, with an area under the curve (AUC) of 0.85. The KRCE performed similarly well in a validation cohort of 12,043 patients undergoing kidney cancer surgery in Ontario, Canada, between 2008 and 2018: AUC, 0.86. The findings were consistent in sensitivity analyses, and the model showed excellent calibration after adjustment of the baseline hazard.

Nephrectomy is an effective treatment for kidney cancers but carries a risk of later decreased kidney function or kidney failure. The KCRE was developed to meet the need for pre-operative tools to predict the long-term risk of kidney failure after surgery for localized kidney cancer.

The new study describes the KCRE as a simple, validated model to predict the risk of developing kidney failure after nephrectomy for kidney cancer. “The KCRE is an easy-to-use tool for urologists and nephrologists to apply in the pre-operative period for risk stratification and patient-centric counselling to identify those at risk of developing post-operative kidney failure in the next 5 years,” the researchers write. They call for further validation in diverse patient samples [Harasemiw O, et al. A predictive model for kidney failure after nephrectomy for localized kidney cancer: The Kidney Cancer Risk Equation. Am J Kidney Dis, published online ahead of print June 30, 2023. doi: 10.1053/j.ajkd.2023.06.002;].