MP57-16 THE ASSOCIATION BETWEEN MODIFIABLE ANESTHETIC PARAMETERS AND RENAL FUNCTION AFTER NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP57)1 Apr 2020MP57-16 THE ASSOCIATION BETWEEN MODIFIABLE ANESTHETIC PARAMETERS AND RENAL FUNCTION AFTER NEPHRECTOMY Roy Mano*, Amy Tin, Andrew Silagy, Samuel Haywood, Chun Huang, Nicole Benfante, Gregory Fischer, Andrew Vickers, Paul Russo, Jonathan Coleman, Patrick McCormick, Joshua Mincer, and A Ari Hakimi Roy Mano*Roy Mano* More articles by this author , Amy TinAmy Tin More articles by this author , Andrew SilagyAndrew Silagy More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Chun HuangChun Huang More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Gregory FischerGregory Fischer More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Paul RussoPaul Russo More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Patrick McCormickPatrick McCormick More articles by this author , Joshua MincerJoshua Mincer More articles by this author , and A Ari HakimiA Ari Hakimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000926.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative anesthetic parameters, primarily intraoperative hypotension, are associated with renal function after surgeries which do not involve the kidney; few studies report their effect in patients undergoing nephrectomy. We evaluated the association between modifiable anesthetic parameters and kidney function after radical and partial nephrectomy. METHODS: We reviewed data from 3,240 consecutive patients who underwent nephrectomy between 2010 – 2018. Intraoperative anesthetic parameters evaluated included duration of hypotension (mean arterial pressure (MAP) <55mmHg), tachycardia (heart rate >100bpm), hypothermia (body temperature <35.5°C) and volatile anesthetic use. MAP at arrival to the post-anesthesia care unit, and total ketorolac dose within 48 hours of surgery were collected. Outcomes included acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) within 1 year after nephrectomy. The associations between the anesthetic parameters and outcomes were evaluated with multivariable logistic regression and longitudinal analyses, respectively, adjusted for known predictors of renal function after nephrectomy. RESULTS: The study cohort included 2111 (65%) males, and the median age was 60 years (IQR 52, 68). Prior to nephrectomy, 677 (21%) patients had stage ≥3 chronic kidney disease (CKD). Over two-thirds (69%) underwent partial nephrectomy. A quarter of the patients had AKI in the immediate postoperative period and 33% had stage ≥3 CKD 12 months after surgery. Most patients were not exposed to intraoperative hypotension [median duration 0 minutes (IQR 0, 2)]. We did not find evidence that intraoperative hypotension was associated with postoperative renal function. Prolonged hypothermia (per 10-min) was consistently associated with an increased rate of AKI (OR 1.02; 95% CI 1.00, 1.04; p=0.024), and a decrease in eGFR (change in eGFR -0.19; 95% CI -0.27, -0.12; p<0.0001). However, while statistically significant, these results have limited clinical significance, aside for a small number of patients exposed to very long hypothermia (Figure 1). CONCLUSIONS: Current practice is aimed at tightly maintaining blood pressure during surgery. Within this setting we did not find an association between intraoperative hypotension and renal function after nephrectomy. Source of Funding: This work was supported by The Sidney Kimmel Center for Prostate and Urologic Cancers. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e867-e868 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roy Mano* More articles by this author Amy Tin More articles by this author Andrew Silagy More articles by this author Samuel Haywood More articles by this author Chun Huang More articles by this author Nicole Benfante More articles by this author Gregory Fischer More articles by this author Andrew Vickers More articles by this author Paul Russo More articles by this author Jonathan Coleman More articles by this author Patrick McCormick More articles by this author Joshua Mincer More articles by this author A Ari Hakimi More articles by this author Expand All Advertisement PDF downloadLoading ...