Independent external validation of a nomogram to define risk categories for a significant decline in estimated glomerular filtration rate after robotic‐assisted partial nephrectomy

• Published in: International journal of urology Vol. 28; no. 1; pp. 75 - 79
• Main Authors: Bajalia, Essa M, Myers, Amanda A, Haehn, Daniela A, Kahn, Amanda E, Ball, Colleen T, Thiel, David D
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.01.2021
• Subjects: Glomerular Filtration Rate; Humans; Kidney - surgery; Kidney Neoplasms - surgery; Nephrectomy; Nephrectomy - adverse effects; nomogram; Nomograms; partial nephrectomy; renal function; Retrospective Studies; Risk groups; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotics; robotic‐assisted partial nephrectomy; Surgery; Treatment Outcome; validation; robotic-assisted partial nephrectomy; renal function; nomogram; partial nephrectomy; validation
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.14404

Objective To validate the Martini nomogram predicting the decline in estimated glomerular filtration rate after robotic‐assisted partial nephrectomy. Methods Estimated glomerular filtration rate of 406 patients from a single surgeon series was calculated before robotic‐assisted partial nephrectomy and at postoperative intervals. To determine the risk group, we calculated the total score and corresponding risk of significant estimated glomerular filtration rate reduction at 15 months using the Martini nomogram. The primary outcome was a reduction in estimated glomerular filtration rate of ≥25% from preoperative levels between 1 and 12 months after surgery. Results The median length of follow up for this study was 12 months (interquartile range 6–12 months). Overall, 134 (33%) patients were in the low‐, 143 (35%) in the intermediate‐, 119 (29%) in the high‐ and 10 (2%) in the very high‐risk groups. The Kaplan–Meier estimates for the probability of significant estimated glomerular filtration rate reduction by 12 months after robotic‐assisted partial nephrectomy was 12.9% in the low‐risk group, 24.0% in the intermediate‐risk group, 49.7% in the high‐risk group and 40.0% in the very high‐risk group. Harrell’s C‐index for discriminating between those with and without a significant reduction in estimated glomerular filtration rate 1–12 months after robotic‐assisted partial nephrectomy was 0.73 (95% confidence interval 0.68–0.78). Conclusions The risk groups proposed by the Martini nomogram are accurate in predicting those at higher risk for a >25% decline in postoperative estimated glomerular filtration rate after robotic‐assisted partial nephrectomy at 12 months.