The Added Value of Controlling Nutritional Status (Conut) Score for Preoperative Counselling on Significant Early Loss of Renal Function After Radical Nephrectomy for Renal Cell Carcinoma

Abstract

Background and objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN).

Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher's exact test for categorical variables and a Mann-Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs).

Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59-0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17-3.09; p 0.05), stage II-III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79-28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58-10.4; p 0.004).

Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN.

Keywords: CONUT; Renal Cell Carcinoma; biomarkers; chronic kidney disease; morbidity; nutritional status assessment; radical nephrectomy.

Figure 1

Receiver operating characteristic (ROC) curve for preoperative prediction of clinically significant eGFR decline defined as the development of a stage ≥ IIIb CKD (eGFR < 45 mL/min) at 24 months after RN. Abbreviations are as follows: eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; RN: radical nephrectomy.

Figure 2

Receiver operating characteristic (ROC) curves for preoperative prediction of clinically significant eGFR decline defined as the development of a stage ≥ IIIb CKD (eGFR < 45 mL/min) at 24 months after RN: (a) age ≥ 70 years old, AUC 0.61 (95%CI, 0.51–0.70); (b) preoperative CKD stage (II–IIIa), AUC 0.53 (95%CI, 0.43–0.62). Abbreviations are as follows: eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; RN: radical nephrectomy; AUC: area under the curve; CIs: Confidence Intervals.