Pre-operative and post-operative estimated glomerular filtration rate in Japanese patients with urological malignancies
- 139 Downloads
The suitable methods evaluating glomerular filtration rate (GFR) have not been established in patients undergoing radical nephrectomy (RN) or radical nephroureterectomy (RNU) due to urological malignancies in Japan as well as worldwide.
We examined the relationship between creatinine clearance-based measured GFR (mGFR) versus estimated GFR (eGFR) calculated by 3 popular equations, 4-variable Modification of Diet in Renal Disease equation adjusted by Japanese correction coefficient (cmMDRD), 3-variable MDRD equation for Japanese population (eGFRcreat), and Chronic Kidney Disease-Epidemiology Collaboration equation adjusted by Japanese correction coefficient (cmCKD-EPI) in Japanese patients who had undergone RN or RNU due to renal cell carcinoma or upper tract urothelial carcinoma before and after surgery.
Among the 3 equations examined, eGFRcreat was the closest to mGFR, although each eGFR was significantly higher than mGFR in the pre-operative period. In the post-operative period, cmMDRD and eGFRcreat, but not cmCKD-EPI, were comparable to mGFR. Each of eGFR was significantly correlated with mGFR in both the pre-operative and post-operative periods. Similar results were obtained by the subanalysis of the patients with pre-operative mGFR of < 60 mL/min/1.73 m2. Results of κ statistics also showed that eGFRcreat was most appropriate to estimate GFR both before and after heminephrectomy, when cut-off value of GFR of < 60 mL/min/1.73 m2 was used.
Results of the present study suggest that eGFRcreat is likely to be the most appropriate equation for patients undergoing RN or RNU due to urological malignancies. However, more precise equations will be required for accurately estimating GFR.
KeywordsNephrectomy Nephroureterectomy Glomerular filtration rate Renal cell carcinoma Upper tract urothelial carcinoma
Compliance with ethical standards
None to report.
Conflict of interest
The authors have declared that no conflict of interest exists.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at Keio University Hospital (IRB Approval Number: 20130424) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The informed consent was waived by the institutional review board at Keio University Hospital, since the patients had left the institution at the time of the study and the study subjects were de-identified.
- 1.Kanayama H, Fukumori T, Fujimoto H, Nakanishi H, Ohyama C, Suzuki K, Nishiyama H, Eto M, Miki T, Kamoi K, Kubota Y, Takahashi S, Homma Y, Naito S. Clinicopathological characteristics and oncologial outcomes in patients with renal cell carcinoma registered in 2007: the first large-scale multicenter study from the cancer registration committee of the Japanese urological association. Int J Urol. 2015;22:S1-S7.CrossRefGoogle Scholar
- 2.Miyazaki J, Nishiyama H. Epidemiology of urothelial carcinoma. Int J Urol. 2017; (In press).Google Scholar
- 3.Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010; 375:2073–81.CrossRefGoogle Scholar
- 4.Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, de Jong PE, Coresh J. Chronic Kidney Disease Prognosis Consortium. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011; 79:1331–40.CrossRefGoogle Scholar
- 6.Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F. Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145:247–54.CrossRefGoogle Scholar
- 11.Ferreira-Filho SR, Cardoso CC, de Castro LA, Oliveira RM, Sá RR. Comparison of measured creatinine clearance and clearances estimated by Cockcroft-Gault and MDRD formulas in patients with a single kidney. Int J Nephrol. 2011;2011:626178.Google Scholar
- 16.Masson I, Flamant M, Maillard N, Rule AD, Vrtovsnik F, Peraldi MN, Thibaudin L, Cavalier E, Vidal-Petiot E, Bonneau C, Moranne O, Alamartine E, Mariat C, Delanaye P. MDRD versus CKD-EPI equation to estimate glomerular filtration rate in kidney transplant recipients. Transplantation. 2013;95:1211–7.CrossRefGoogle Scholar