A systematic review of the quality of evidence of ablative therapy for small renal masses

Purpose: We critically assessed the methodological and reporting quality of published studies of ablative techniques for small renal masses. Materials and Methods: We performed a systematic PubMed® and EMBASE® literature search from January 1966 to March 2010 to identify all full text, original research publications on ablative therapy for renal masses. Six reviewers working independently in 3 teams performed duplicate data abstraction using Strengthening the Reporting of Observational Studies in Epidemiology criteria, which were pilot tested in a separate sample. Results: A total of 117 original research publications published in a 15-year period (1995 to 2009) met eligibility criteria. No randomized, controlled trials were identified. All studies were observational and 88.9 had 1 arm with no comparison group. Median sample size was 18 patients (IQR 5.5, 40.0) and 53.8 of studies included 20 or fewer patients. Median followup was 14.0 months (IQR 8.0, 23.8) and only 19.7 of studies had an average followup of greater than 24 months. Of the studies 20.5 mentioned the number of operators involved and only 6.0 provided information on their experience level. Of the studies 66.7 addressed the recurrence rate. Disease specific and overall survival was reported in only 15.4 and 16.2 of studies, respectively. Conclusions: The published literature on the therapeutic efficacy of ablative therapy for renal masses is largely limited to uncontrolled, 1-arm observational studies. In the absence of higher quality evidence ablative therapy outside research studies should be limited to select patients who are not candidates for surgical intervention. © 2012 American Urological Association Education and Research, Inc

Supplementary Material for: Estimated GFR and Mortality in Older Men: Are All eGFR Formulae Equal?

<b><i>Background:</i></b> Recently, the first estimated glomerular filtration rate (eGFR) formula specifically developed for community-dwelling older adults, the Berlin Initiative Study Equation 2 (BIS2), was reported. To date, however, no study has examined the performance of the BIS2 to predict death in older adults as compared to equations used clinically and in research. <b><i>Methods:</i></b> We prospectively followed 2,994 community-dwelling men (age 76.4 ± 5.6) enrolled in the MrOS Sleep Study. We calculated baseline eGFR from serum creatinine and cystatin-C using the BIS2, Chronic Kidney Disease Epidemiology (CKD-EPI_cr,cysc), CKD-EPI_cysc and CKD-EPI_cr equations. Analyses included Cox-proportional hazards regression and net reclassification improvement (NRI) for the outcomes of all-cause and cardiovascular death. <b><i>Results:</i></b> Follow-up time was 7.3 ± 1.9 years. By BIS2, 42 and 11% had eGFR <60 and <45, respectively, compared to CKD-EPI_cr (23 and 6%), CKD-EPI_cysc (36 and 13%) and CKD-EPI_cr,cysc (28 and 8%). BIS2 eGFR <45 was associated with twofold higher rate of all-cause mortality when compared to eGFR ≥75 after multivariate adjustment (HR 2.1, 95% CI 1.5-2.8). Results were similar for CKD-EPI_cr,cysc <45 (HR 2.1, 95% CI 1.6-2.7) and CKD-EPI_cysc <45 (HR 2.1, 95% CI 1.7-2.7) and weaker for CKD-EPI_cr <45 (HR 1.5, 95% CI 1.2-2.0). In NRI analyses, when compared to CKD-EPI_cr,cysc, both BIS2 and CKD-EPI_cr equations more often misclassified participants with respect to mortality. We found similar results for cardiovascular death. <b><i>Conclusion:</i></b> The BIS2 did not outperform and the CKD-EPI_cr was inferior to the cystatin C-based CKD-EPI equations to predict death in this cohort of older men. Thus, the cystatin C-based CKD-EPI equations are the formulae of choice to predict death in community-dwelling older men