MP64-15 DETERMINANTS OF RENAL FUNCTIONAL DECLINE AFTER OPEN PARTIAL NEPHRECTOMY: A COMPARISON OF WARM, COLD, AND NON-ISCHEMIC MODALITIES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-15 DETERMINANTS OF RENAL FUNCTIONAL DECLINE AFTER OPEN PARTIAL NEPHRECTOMY: A COMPARISON OF WARM, COLD, AND NON-ISCHEMIC MODALITIES Ramzi Jabaji, Michael Liss, Kerrin Palazzi, Hak Lee, Jason Woo, Reza Mehrazin, Hossein Mirheydar, Sean Stroup, James Masterson, Ryan Kopp, Anthony Patterson, James L'Esperance, and Ithaar Derweesh Ramzi JabajiRamzi Jabaji More articles by this author , Michael LissMichael Liss More articles by this author , Kerrin PalazziKerrin Palazzi More articles by this author , Hak LeeHak Lee More articles by this author , Jason WooJason Woo More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Hossein MirheydarHossein Mirheydar More articles by this author , Sean StroupSean Stroup More articles by this author , James MastersonJames Masterson More articles by this author , Ryan KoppRyan Kopp More articles by this author , Anthony PattersonAnthony Patterson More articles by this author , James L'EsperanceJames L'Esperance More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1932AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal functional decline after partial nephrectomy (PN) may be related to a variety of non−modifiable and modifiable factors, particularly ischemia time (IT) and temperature. We sought to determine the impact of these factors on renal functional degeneration after PN. METHODS Multicenter retrospective analysis (n=347) was performed, identifying patients who underwent open PN using warm-ischemic, cold-ischemic, and clampless techniques. Primary outcome was development of de novo CKD (estimated glomerular filtration rate, eGFR <60 ml/min/1.73 m2, by MDRD equation) at last follow up. Secondary outcome was change in eGFR between preoperative value and value at last follow up. Univariate and multivariable analysis (MVA) were performed examining factors associated with ischemia technique and the development of de novo CKD. RESULTS Median follow-up 34.7 months. 241 patients underwent warm-ischemic, 31 cold-ischemic, and 75 clampless PN. Patient characteristics were similar between groups. No significant differences were noted in incidence of preoperative CKD (p=0.146) and mean preoperative eGFR (0.377). Lower mean RENAL nephrometry scores were noted in the clampless group compared to the cold (6.4 vs. 7.9; p=0.005) and warm (6.4 vs. 7; p=0.037) ischemia groups. Cold ischemia cohort had longer median IT than the warm cohort (50 vs. 25 min; p=0.001). There were no significant differences in proportion of patients developing de novo CKD (warm 13.8%, cold 12.5%, clampless 8.7%, p=0.542). Mean change in eGFR from baseline to last follow up was not significantly different between the groups (warm -15.1, cold -12.7, clampless -13.2, p=0.364). MVA demonstrated that neither ischemic modality nor IT ≥30 minutes was associated with development of de novo CKD, while RENAL scores of increasing complexity (RENAL score 7-9, OR 4.3, p=0.003; RENAL score ≥10 OR 15.4, p<0.001) were independently associated with de novo CKD. CONCLUSIONS Increasing tumor complexity, as indicated by the RENAL score, has more impact on post PN renal functional outcome than ischemia time or technique. Prospective investigation is requisite to elucidate risk and protective factors for renal functional degeneration after PN. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e706 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ramzi Jabaji More articles by this author Michael Liss More articles by this author Kerrin Palazzi More articles by this author Hak Lee More articles by this author Jason Woo More articles by this author Reza Mehrazin More articles by this author Hossein Mirheydar More articles by this author Sean Stroup More articles by this author James Masterson More articles by this author Ryan Kopp More articles by this author Anthony Patterson More articles by this author James L'Esperance More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...