Impact of Mayo Adhesive Probability score and BMI on renal functional decline after robotic assisted partial nephrectomy

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass Pub Date : 2024-08-30 DOI:10.1002/bco2.417

Cesare Saitta, Marco Paciotti, Giovanni Lughezzani, Giuseppe Garofano, Margaret F. Meagher, Kit L. Yuen, Vittorio Fasulo, Roberto Contieri, Pier Paolo Avolio, Andrea Piccolini, Paola Arena, Matilde Mantovani, Edoardo Beatrici, Marta Calatroni, Francesco Reggiani, Rodolfo F. Hurle, Massimo Lazzeri, Alberto Saita, Paolo Casale, Ithaar H. Derweesh, Nicolò M. Buffi

{"title":"Impact of Mayo Adhesive Probability score and BMI on renal functional decline after robotic assisted partial nephrectomy","authors":"Cesare Saitta, Marco Paciotti, Giovanni Lughezzani, Giuseppe Garofano, Margaret F. Meagher, Kit L. Yuen, Vittorio Fasulo, Roberto Contieri, Pier Paolo Avolio, Andrea Piccolini, Paola Arena, Matilde Mantovani, Edoardo Beatrici, Marta Calatroni, Francesco Reggiani, Rodolfo F. Hurle, Massimo Lazzeri, Alberto Saita, Paolo Casale, Ithaar H. Derweesh, Nicolò M. Buffi","doi":"10.1002/bco2.417","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>The purpose of this study is to investigate the impact of Mayo Adhesive Probability (MAP) score and body mass index (BMI) on renal function decline after robotic assisted partial nephrectomy (RAPN).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We queried our prospective database for patients who underwent RAPN between January 2018 and December 2023. Outcomes were development of de novo CKD-S3 (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m<sup>2</sup>). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S3. Kaplan–Meier Analyses was fitted for survival assessment. Finally, multivariable linear regression was utilized to identify predictors of delta eGFR at last follow-up (preoperative eGFR—last eGFR).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Two-hundred fifty-eight patients were analysed (obese <i>n</i> = 49 [19%]; MAP score 0–2 = 135 [52.33%]; MAP score 3–5 = 123 [47.6%]) with a median follow-up of 33 (IQR 20–42) months. MVA revealed, high MAP score (HR 2.29, <i>p</i> = 0.019), increasing RENAL score (HR 1.26, <i>p</i> = 0.009), increasing age (HR 1.04, <i>p</i> = 0.003), obesity (HR 2.38, <i>p</i> = 0.006) and diabetes mellitus (HR 2.38, <i>p</i> = 0.005) as associated with increased risk of development of CKD-S3, while trifecta achievement was not (<i>p</i> = 0.63). Comparing low MAP score versus high MAP score 4-year CKD-S3 free survival was 87.8% versus 56.1% (<i>p</i> < 0.001). Multivariable linear regression showed that high MAP score (coefficient 6.64, <i>p</i> = 0.001) and BMI (coefficient 0.51, <i>p</i> = 0.011) were significantly associated with increased delta eGFR at last follow up.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>MAP score and increasing BMI are predictor for long term renal functional detrimental. These insights may call consideration for closer follow-up or greater medical scrutiny prior surgery in obese patients and with elevated MAP score. Further investigations are requisite.</p>\n </section>\n </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 10","pages":"942-949"},"PeriodicalIF":1.6000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.417","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJUI compass","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/bco2.417","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

The purpose of this study is to investigate the impact of Mayo Adhesive Probability (MAP) score and body mass index (BMI) on renal function decline after robotic assisted partial nephrectomy (RAPN).

Methods

We queried our prospective database for patients who underwent RAPN between January 2018 and December 2023. Outcomes were development of de novo CKD-S3 (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m²). Multivariable analysis (MVA) via Cox regression identified predictors for CKD-S3. Kaplan–Meier Analyses was fitted for survival assessment. Finally, multivariable linear regression was utilized to identify predictors of delta eGFR at last follow-up (preoperative eGFR—last eGFR).

Results

Two-hundred fifty-eight patients were analysed (obese n = 49 [19%]; MAP score 0–2 = 135 [52.33%]; MAP score 3–5 = 123 [47.6%]) with a median follow-up of 33 (IQR 20–42) months. MVA revealed, high MAP score (HR 2.29, p = 0.019), increasing RENAL score (HR 1.26, p = 0.009), increasing age (HR 1.04, p = 0.003), obesity (HR 2.38, p = 0.006) and diabetes mellitus (HR 2.38, p = 0.005) as associated with increased risk of development of CKD-S3, while trifecta achievement was not (p = 0.63). Comparing low MAP score versus high MAP score 4-year CKD-S3 free survival was 87.8% versus 56.1% (p < 0.001). Multivariable linear regression showed that high MAP score (coefficient 6.64, p = 0.001) and BMI (coefficient 0.51, p = 0.011) were significantly associated with increased delta eGFR at last follow up.

Conclusions

MAP score and increasing BMI are predictor for long term renal functional detrimental. These insights may call consideration for closer follow-up or greater medical scrutiny prior surgery in obese patients and with elevated MAP score. Further investigations are requisite.

Abstract Image

查看原文本刊更多论文

梅奥粘连概率评分和体重指数对机器人辅助肾部分切除术后肾功能衰退的影响

目的本研究旨在探讨梅奥粘连概率（MAP）评分和体重指数（BMI）对机器人辅助肾部分切除术（RAPN）后肾功能下降的影响。方法我们在前瞻性数据库中查询了 2018 年 1 月至 2023 年 12 月间接受 RAPN 的患者。结果为出现新的 CKD-S3（估计肾小球滤过率 [eGFR] < 60 ml/min/1.73 m2）。通过 Cox 回归进行的多变量分析 (MVA) 确定了 CKD-S3 的预测因素。Kaplan-Meier 分析用于生存评估。最后，利用多变量线性回归确定了最后一次随访时 eGFR δ（术前 eGFR-最后一次 eGFR）的预测因素。结果分析了 258 名患者（肥胖者 n = 49 [19%]；MAP 评分 0-2 = 135 [52.33%]；MAP 评分 3-5 = 123 [47.6%]），中位随访时间为 33 个月（IQR 20-42）。MVA显示，高MAP评分（HR 2.29，P = 0.019）、RENAL评分增加（HR 1.26，P = 0.009）、年龄增加（HR 1.04，P = 0.003）、肥胖（HR 2.38，P = 0.006）和糖尿病（HR 2.38，P = 0.005）与CKD-S3的发病风险增加有关，而三项指标达标与CKD-S3的发病风险增加无关（P = 0.63）。低 MAP 评分与高 MAP 评分的 4 年无 CKD-S3 存活率分别为 87.8% 与 56.1%（p < 0.001）。多变量线性回归显示，高 MAP 评分（系数 6.64，p = 0.001）和体重指数（系数 0.51，p = 0.011）与最后一次随访时 delta eGFR 的增加显著相关。结论 MAP 评分和体重指数的增加是长期肾功能损害的预测因素。这些启示可能要求对肥胖和 MAP 评分升高的患者在手术前进行更密切的随访或更严格的医疗检查。进一步的调查是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BJUI compass

CiteScore

2.30

自引率

0.00%

发文量

审稿时长

12 weeks