Investigators have created a model to preoperatively identify which patients undergoing nephrectomy for localized kidney cancer are at risk for kidney failure within 5 years.

The Kidney Cancer Risk Equation (KCRE) incorporates readily available clinical information including patient age, sex, estimated glomerular filtration rate (eGFR), urinary albumin to creatinine ratio (UACR), history of diabetes mellitus, and surgical approach (partial or radical nephrectomy), Navdeep Tangri, MD, PhD, of the Chronic Disease Innovation Centre in Winnipeg, Manitoba, Canada, and colleagues reported in the American Journal of Kidney Diseases.

In a development cohort including 1026 patients from Manitoba, Canada, 10.3% experienced an eGFR decline to less than 15 mL/min/1.73m2, initiated dialysis, or underwent transplantation for kidney failure. In a validation cohort including 12,403 patients in Ontario, 6.3% progressed to kidney failure. According to the investigators, the KCRE model yielded an area under the curve of 0.85 in the development cohort and 0.86 in the validation cohort for predicting end-stage kidney disease within 5 years in these cohorts.

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“From a clinical perspective, the KCRE can be used by surgeons to counsel patients on postoperative risks associated with surgery, and help guide referral to nephrology early-on in the care of high-risk patients who choose to proceed with surgery,” Dr Tangri’s team wrote.

Other preoperative equations currently in use predict stage 3 chronic kidney disease or require more variables for assessing kidney failure risk.

Among the study’s limitations, the KCRE model used race-based rather than new race-free eGFR equations, and UACR was missing in up to 40% of patients, so further validation is needed.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Harasemiw O, Nayak JG, Grubic N, Ferguson TW, Sood MM, Tangri N. A predictive model for kidney failure after nephrectomy for localized kidney cancer: the kidney cancer risk equation. Am J Kidney Dis. Published online June 30, 2023. doi:10.1053/j.ajkd.2023.06.002