Kidney Week

Abstract: FR-PO215

Performance of a Score for Stratifying the Risk of CKD in Patients with Renal Cell Carcinoma Undergoing Nephrectomy

Session Information

• Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Kassar, Liliana M L, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil

Liliana M L Kassar, MD

• Costa e Silva, Veronica Torres, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil

Veronica Torres Costa e Silva, MD

• Pereira, Benedito J., Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Benedito J. Pereira, MD, PhD

• Lutf, Luciana Gil, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil

Luciana Gil Lutf, MD

• Mattedi, Francisco Zanotelli, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil

Francisco Zanotelli Mattedi, MD

• Silva, Karoline W C, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil

Karoline W C Silva, MD

• Cordeiro, Mauricio Dener, Universidade de Sao Paulo Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, São Paulo, Brazil

Mauricio Dener Cordeiro, MD, PhD

• Zanetta, Dirce M T, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Dirce M T Zanetta, MD, PhD

• Burdmann, Emmanuel A., Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Emmanuel A. Burdmann, MD, PhD

Background

Nephrectomy to treat patients with kidney cancer increases the risk of chronic kidney disease (CKD) in the middle and long term. Although new clinical tools have been developed to identify patients at higher risk and promote appropriate follow-up, these instruments have not been externally validated. We aim to assess the performance of the Australian risk stratification score for CKD (ARSC) after nephrectomy in patients with renal cell carcinoma (RCC).

Methods

We screened all adult patients with histology-confirmed RCC submitted to partial or total nephrectomy between 2010 and 2021 at the São Paulo State Cancer Institute – University of São Paulo (Brazil). Patients with a pre-operative (baseline) estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m² and with at least one eGFR between 12 and 15 months after surgery were included. The ARSC score was calculated based on baseline characteristics (age, eGFR, diabetes mellitus [DM]) and type of nephrectomy. The primary outcome was eGFR ≤ 45 m/min/1.73m² (stage 3b CKD) one year after nephrectomy. eGFR was calculated using the race-free CKD-EPI equation based on the serum creatinine level.

Results

We enrolled 349 patients. The mean age was 58±10 y, 61% were male; 60% and 27% had hypertension and DM, respectively. Median baseline eGFR was 91 (63-123) mL/min/1.73m²; nephrectomy was radical in 49% of patients. The ARSC score presented satisfactory discrimination; the area under the receiver operation characteristic curve was 0.70 (0.57 – 0.80, p=0.01). However, the score overestimated the outcome in patients at moderate and high risk (≥ 7 points) (Table).

Conclusion

The ARSC score presented satisfactory discrimination but overestimated the outcome of stage 3b CKD in this Brazilian cohort of patients with RCC.

ARSC: Australian risk stratification score for CKD; CKD: chronic kidney disease