MP42-05 ACUTE KIDNEY INJURY AND INTERMEDIATE-TERM RENAL FUNCTION AFTER CLAMPLESS PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-05 ACUTE KIDNEY INJURY AND INTERMEDIATE-TERM RENAL FUNCTION AFTER CLAMPLESS PARTIAL NEPHRECTOMY Minato Yokoyama, Naoko Kawamura, Sho Uehara, Yosuke Yasuda, Toshiki Kijima, Soichiro Yoshida, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii Minato YokoyamaMinato Yokoyama More articles by this author , Naoko KawamuraNaoko Kawamura More articles by this author , Sho UeharaSho Uehara More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1312AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Some patients experience acute kidney injury (AKI) after partial nephrectomy (PN). The incidence of AKI after PN with hilar clamping has been reported in several studies, and some investigators demonstrated the association of duration or type of ischemia with the incidence of AKI. However, the incidence of AKI after clampless PN and the influence of AKI after PN on longitudinal change in postoperative renal function have not been fully explored. Here, we investigated associations between AKI and intermediate-term renal function after clampless PN. METHODS Between 2010 and 2015, 337 consecutive patients underwent gasless single-port PN and were followed up longer than 1 year. In this surgery, PN was done with an extraperitoneal approach via a single-port without gas insufflation and hilar clamping by using soft coagulation and ultrasonic coagulation system. Of the 337 patients, those with bilateral tumors (n=26), metastases (n=6), solitary kidney (n=4), and those requiring hilar clamping (n=21) were excluded. The association between the occurrence of AKI based on AKI network definition and renal impairment with ≥25% estimated glomerular filtration rate (eGFR) decrease was evaluated using Cox regression model.Then, mean eGFRs of the patients with or without AKI after clampless PN up to 5 years were plotted, and an annual change of eGFR from 1 year after surgery was calculated using linear mixed model. RESULTS Of the 280 patients, Median age, preoperative eGFR, tumor size, operation time, and blood loss was 58 years, 70.6 ml/min/1.73 m2, 2.5 cm, 214 minutes, and 314 ml, respectively. Hypertension, diabetes mellitus, dyslipidemia, and cardiovascular disease coexisted in 38%, 10%, 15%, and 9% of the subjects, respectively. AKI occurred in 21 patients (8%), and all the AKIs observed were grade 1. Median eGFR change at latest follow up (median 36 months) was -9.0%. During the follow up period, no patients required renal replacement therapy.Cox regression analysis showed that AKI was not associated with renal impairment after clampless PN, while advanced age (≥65) and presence of diabetes mellitus were independent risk factors.Annual eGFR changes from 1 year after clampless PN in patients with and without AKI were -0.34 (95% CI: -1.23 ~ 0.54) ml/min/1.73 m2 and -0.36 (-0.72 ~ -0.02) ml/min/1.73 m2, respectively. CONCLUSIONS Renal function was well preserved after clampless PN. The incidence and severity of AKI were low, and AKI after clampless PN was not associated with intermediate-term renal impairment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e537-e538 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Minato Yokoyama More articles by this author Naoko Kawamura More articles by this author Sho Uehara More articles by this author Yosuke Yasuda More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...