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

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

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

BJUI Compass. 2024 Aug 30;5(10):942-949. doi: 10.1002/bco2.417. eCollection 2024 Oct.

Authors

Cesare Saitta^{1

2

3}, Marco Paciotti¹, Giovanni Lughezzani^{1

2}, Giuseppe Garofano^{1

2}, Margaret F Meagher³, Kit L Yuen³, Vittorio Fasulo^{1

2}, Roberto Contieri^{1

2}, Pier Paolo Avolio^{1

2}, Andrea Piccolini^{1

2}, Paola Arena^{1

2}, Matilde Mantovani², Edoardo Beatrici^{1

2}, Marta Calatroni^{2

4}, Francesco Reggiani^{2

4}, Rodolfo F Hurle¹, Massimo Lazzeri¹, Alberto Saita¹, Paolo Casale¹, Ithaar H Derweesh³, Nicolò M Buffi^{1

2}

Affiliations

¹ Department of Urology IRCCS Humanitas Research Hospital Rozzano Italy.
² Biomedical Science Humanitas University Pieve Emanuele Italy.
³ Department of Urology UC San Diego Health System La Jolla California USA.
⁴ Nephrology and Dialysis Division IRCCS Humanitas Research Hospital Rozzano Italy.

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.

Keywords: BMI; CKD‐S; MAP score; estimated glomerular filtration rate; functional decline; obesity; renal cell carcinoma; survival analysis.