You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-02 IS GFR ENOUGH TO DEFINE CHRONIC KIDNEY DISEASE IN KIDNEY CANCER PATIENTS? Kelly O'Donnell, Conrad Tobert, Brad Boelkins, Sabrina Noyes, Samer Kirmiz, Mwafa Tourojman, George Ghareeb, Joseph Giovanucci, Sevag Demirjian, and Brian Lane Kelly O'DonnellKelly O'Donnell More articles by this author , Conrad TobertConrad Tobert More articles by this author , Brad BoelkinsBrad Boelkins More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Samer KirmizSamer Kirmiz More articles by this author , Mwafa TourojmanMwafa Tourojman More articles by this author , George GhareebGeorge Ghareeb More articles by this author , Joseph GiovanucciJoseph Giovanucci More articles by this author , Sevag DemirjianSevag Demirjian More articles by this author , and Brian LaneBrian Lane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1544AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic kidney disease is defined as GFR <60ml/min/1.73m2 or structural/functional abnormalities (regardless of GFR) and irrespective of cause. Prior studies have found that 26-30% of patients with suspected renal cancers have GFR<60. We investigated the extent of proteinuria to determine the impact on identification and classification of CKD in these patients. METHODS An institutional database was queried for renal mass patients with measurement of both serum creatinine and proteinuria prior to initial treatment. Among 1220 patients evaluated between 1999 and 2014, 710 met inclusion criteria. Preoperative GFR was calculated using CKD-EPI and urinalysis-determined proteinuria was grouped as <30 mg (A1), 30 to 300 mg (A2), and >300 mg (A3). Patients were classified according to risk of CKD progression into low, moderately-increased, high, and very high risk groups (KDIGO 2012). Univariable and multivariable analyses of CKD prevalence defined by reduced GFR, proteinuria, and KDIGO classification were performed based on known risk factors including age, race, gender, tumor size, hypertension, diabetes mellitus, coronary artery disease, and peripheral vascular disease. RESULTS Mean GFR was 73.3 ml/min/1.73m2 (range: 4-204), with 30.4% having GFR<60, including 183 with GFR 30-59.9 (25.8%) and 33 with GFR <29.9 (4.7%). Proteinuria was present in 25.9% of patients at baseline, including 150 patients with 30-300mg (A2: 21.1%), and 34 with >300mg (A3: 4.8%). Proteinuria was detected in 108 patients (21.8%) with normal GFR and 76 patients with GFR<60 (35.2%). KDIGO classification yielded patients with low (54%, n=385), moderately-increased (25%, n=180), high (13%, n=82), very high (9%, n=63) for CKD progression. Thirty of 184 patients (16.3%) with moderate CKD by GFR (30-59.9) were reclassified as very high risk based on proteinuria status. Significant predictors (p<0.05) in multivariable analyses included age, race, gender, tumor size and reduced GFR for proteinuria (A2/A3 vs. A1); age, diabetes, and proteinuria for reduced GFR; and age, tumor size, and hypertension for KDIGO risk classification. CONCLUSIONS Accurate assessment of renal function prior to surgery can facilitate decision-making and management for patients with renal tumors. In this population, 22% of patients at increased risk of CKD progression were overlooked by relying solely on GFR and 16% of moderate-risk patients were re-classified as very high risk. We would advocate for routine determination of proteinuria prior to intervention for renal masses to better classify CKD in these at-risk patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e526-e527 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly O'Donnell More articles by this author Conrad Tobert More articles by this author Brad Boelkins More articles by this author Sabrina Noyes More articles by this author Samer Kirmiz More articles by this author Mwafa Tourojman More articles by this author George Ghareeb More articles by this author Joseph Giovanucci More articles by this author Sevag Demirjian More articles by this author Brian Lane More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...