Preoperative eGFR Research Articles

Reliability and Validity of a New Baseline Renal Function Calculator after Radical Nephrectomy in a Malaysian Population

Purpose: This study aimed to determine the reliability and validity of a new baseline renal function calculator after radical nephrectomy in Malaysian patients. Materials and Methods: This study retrospectively collected data on patients' demographics, tumor characteristics, and baseline estimated glomerular filtration rate (eGFR) during radical nephrectomy from a single urology center from 2015 to 2020. The predicted eGFR was determined using a calculator. Predicted eGFR was validated by performing simple linear regression and Pearson coefficient correlations; reliability was determined by calculating Shrout and Fleiss's intraclass correlation coefficients. Results: Fifty-two patients (mean age, 57.5 years) were enrolled in this study. Thirty-seven (71.2%) patients were men, and 15 (28.8%) had diabetes. Most of the patients (90.2%) had a baseline eGFR of >60 mL/min/1.73 m2. The mean preoperative eGFR was 85.33 mL/min/1.73 m2, whereas the mean postoperative eGFR was 59.88 mL/min/1.73 m2. Simple linear regression analysis resulted in an R2 value of 0.700. The predicted eGFR was significantly correlated with the actual eGFR 6 months after radical nephrectomy (r = 0.837, P< 0.0001). The intraclass correlation coefficient value of 0.83 indicated good reliability of the formula. Conclusion: Our new validated and reliable baseline renal function calculator can provide easy and rapid prediction of renal function in patients scheduled for radical nephrectomy in a sample Malaysian population.

Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer

BackgroundPatients with chronic kidney disease (CKD) are poor candidates for standard treatments for muscle-invasive bladder cancer (MIBC) and may be more likely to experience adverse outcomes when diagnosed with MIBC. ObjectiveTo investigate factors associated with the development of advanced CKD following radical cystectomy. Design, setting, and participantsUsing national Veterans Health Administration utilization files, we identified 3360 patients who underwent radical cystectomy for MIBC between 2004 and 2018. Outcome measurements and statistical analysisWe examined factors associated with the development of advanced CKD (estimated glomerular filtration rate [eGFR] of <30 ml/min/1.73 m2) after radical cystectomy using multivariable logistic and proportional hazard regression, with and without consideration of competing risks. We examined survival using Kaplan-Meier product limit estimates and proportional hazard regression. Results and limitationsThe median age at surgery was 67 yr and the mean preoperative eGFR was 69.1 ± 20.3 ml/min/1.73 m2. Approximately three out of ten patients (n = 962, 29%) progressed to advanced CKD within 12 mo. Older age (hazard ratio [HR] per 5-yr increase 1.15, 95% confidence interval [CI] 1.10–1.20), preoperative hydronephrosis (HR 1.50, 95% CI 1.29–1.76), adjuvant chemotherapy (HR 1.19, 95% CI 1.00–1.41), higher comorbidity index (HR 1.13, 95% CI 1.11–1.16 per point), and lower baseline kidney function (HR 0.75, 95% CI 0.73–0.78) were associated with the development of advanced CKD. Baseline kidney function at the time of surgery was associated with survival. Generalizability is limited due to the predominantly male cohort. ConclusionsImpaired kidney function at baseline is associated with progression to advanced CKD and mortality after radical cystectomy. Preoperative kidney function should be incorporated into risk stratification algorithms for patients undergoing radical cystectomy. Patient summaryImpaired kidney function at baseline is associated with progression to advanced chronic kidney disease and mortality after radical cystectomy.

Factors associated with acute kidney injury and mortality during cardiac surgery.

Cardiac surgery with cardiopulmonary bypass (CPB) is known to contribute towards the incidence of acute kidney injury (AKI) and peri-operative morbidity and mortality. There are several patient, anaesthetic and surgical factors that contribute to its occurrence. It is imperative to know the profile of a patient who is likely to develop this complication to mitigate for modifiable risks. This study aimed at describing a profile of AKI in an adult patient (over the age of 18 years) following cardiac surgery on CPB. Factors associated with the development of cardiac surgery-associated acute kidney injury (CSA-AKI) are described, as well as the relationship between CSA-AKI and in-hospital mortality. This was a contextual, descriptive and retrospective single-centre study with data of 476 adult patients admitted post cardiac surgery between January 2016 and December 2017. Data were collected from Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa. All adult patients who presented for elective cardiac surgery (coronary artery bypass graft), valvular, aortic and other cardiac surgery on CPB were included. Peri-operative factors such as patient demographics, baseline renal function, co-morbid factors, length of CPB and aortic cross-clamp time, degree of hypothermia, use of assist devices, and post-operative serum creatinine (SCr) levels were collected. Incomplete essential peri-operative data and data for patients who presented on renal replacement therapy (RRT) already were excluded. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. One hundred and thirty-five (28%) patients developed CSA-AKI and 20, 5 and 3% were in KDIGO 1, 2 and 3, respectively. Older age (p = 0.024), female gender (p = 0.015), higher serum creatinine level (p = 0.025), and lower estimated glomerular filtration rate (eGFR) (p = 0.025) were associated with the development of CSA-AKI, while a history of hypertension was predictive. Forty-six of the 476 patients died. Mortality rates were significantly higher in those with AKI compared to those without [28 (21%) vs 18 (5%), respectively (p = 0.001)]. The incidence was significantly worse in those with severe kidney injury, as evidenced by mortality rates of 44 versus 5% between KDIGO 3 and KDIGO 1 (p < 0.001). Pre-operative eGFR and CSA-AKI requiring RRT were significantly associated with mortality, while pre-operative eGFR was an independent predictor of mortality (hazard ratio 0.99, 95% confidence interval: 0.97-0.99, p = 0.019). A history of hypertension was predictive of the development of CSA-AKI, and pre-operative eGFR was an independent predictor of mortality in this cohort. Both factors are modifiable.

Long-Term Renal Function Following Radical Cystectomy for Bladder Cancer

ObjectiveTo evaluate long-term renal function following radical cystectomy (RC) for bladder cancer and identify risk factors associated with postoperative decline in renal function. MethodsThe study included patients who underwent RC at a single centre in Denmark between 2009 and 2019. Data was collected through national electronic medical records. Renal function was evaluated by estimated glomerular filtration rate (eGFR) using pre- and postoperative creatinine measurements. Cumulative incidence and Cox Proportional Hazards models were used to describe the loss of renal function and its association with clinicopathological variables, as well as its effect on mortality. ResultsAfter exclusions, 670 patients were eligible for analyses. Median follow-up time was 6.2 years (interquartile range 4.0 –8.4). The proportion of patients with renal insufficiency (eGFR<45 mL/min) increased from 8.9% before RC to 19% 5 years after surgery. A total of 610 patients with preoperative eGFR≥45 were included in survival analyses. The absolute risk of renal function decline to CKD stage G3b or worse (eGFR<45 mL/min) was 17% (95% CI 14 –20) at 5 years postoperatively. Loss of renal function was not significantly associated with higher all-cause mortality. In multivariate analysis lower preoperative eGFR, diabetes mellitus, prior pelvic radiation therapy, continent urinary diversion types, and postoperative ureteral stricture were all independently associated with renal function decline. ConclusionThe long-term renal function decreases considerably for a large number of RC patients. Recognizing preoperative risk factors could identify patients who benefit from enhanced renal surveillance or early intervention for modifiable factors to minimize renal insufficiency following RC.

Abstract 9431: Preoperative Serum Gdf-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery

Introduction: The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk. Hypothesis: To investigate the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery. Methods: Total 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by Enzyme-Linked Immunosorbent Assay. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria. Results: AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels; perioperative data (urine output); ICU stay period; and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. The risk of developing AKI increased with increasing preoperative ET-1 level at baseline (OR for 1 pg/mL increase in ET-1, 2.177; 95% CI, 1.034-4.584; p = 0.041) and CPB time (OR for 1 h increase in CPB time, 4.194; 95% CI, 2.005-8.773; p &lt; 0.001), even adjusted by age, sex, and BMI. In addition, multivariable logistic regression analysis showed that the risk of 30-day mortality plus morbidity increased with increasing preoperative GDF-15 level at baseline, CPB time, and RCC transfusion, even adjusted for age, gender, and BMI. Conclusion: The present study provides evidence that preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risk for patients undergoing cardiovascular surgery.

Remnant renal volume can predict prognosis of remnant renal function in kidney transplantation donors: a prospective observational study

BackgroundSafety and survival during and after donor nephrectomy (DN) are one of the main concerns in living kidney donors (LKDs). Therefore, kidney (left/right) to be procured should be determined after considering the difficulty of DN, as well as the preservation of remnant renal function (RRF). In this prospective study, we investigated the roles of computed tomography volumetry (CTV) in split renal function (SRF) and established a predictive model for RRF in LKDs.MethodsWe assessed 103 LKDs who underwent DN at our institute. The Volume Analyzer SYNAPSE VINCENT image analysis system were used as CTV. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN. The association between various factors measured by CTV and RRF were investigated, and a role of CTV on prediction for RRF was assessed.ResultsThe median age and the preoperative eGFR were 58 years and 80.7 mL/min/1.73m2, respectively. Each factor measured by CTV showed an association with RRF. The ratio of remnant renal volume to body surface area (RRV/BSA) could predict RRF. In addition, RRV/BSA could predict RRF more accurately when used together with age and 24-h creatinine clearance (CrCl).ConclusionsOur findings suggest that RRV/BSA measured by CTV can play an important role in predicting RRF, and a comprehensive assessment including age and CrCl is important to determine the kidney to be procured.

Preoperative mineralocorticoid receptor antagonist reduces postoperative hyperkalaemia in patients with Conn syndrome.

The preoperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral forms of primary aldosteronism (PA) is not standardized. The current Endocrine Society Guidelines do not specifically recommend MRA treatment before surgery. It is unclear whether preoperative MRA can optimize perioperative blood pressure and potassium control, and reduce the incidence of postoperative hyperkalaemia. This study aimed to investigate the effect of MRA on the incidence of postoperative hyperkalaemia in addition to perioperative blood pressure and potassium concentration in patients undergoing unilateral adrenalectomy for the treatment of PA. Retrospective cohort study. Tertiary referral centres, Victoria, Australia. A total of 96 patients who were diagnosed with unilateral forms of PA: 73 patients ('MRA' group) received preoperative MRA while 23 patients ('No-MRA' group) did not. The prevalence of postoperative hyperkalaemia was significantly higher in the 'No-MRA' group at 2-4 weeks after surgery, compared to the 'MRA' group (35% vs. 11%, p = .014). In a logistic regression, the use of MRA significantly predicted a lower incidence of postoperative hyperkalaemia after adjusting for age, sex, baseline aldosterone-to-renin ratio, potassium and preoperative eGFR. Before surgery, patients in the 'MRA' group had normalized blood pressure and potassium concentration requiring fewer antihypertensive medications and no potassium supplements. Preoperative MRA use was associated with optimal perioperative blood pressure and normalized serum potassium in addition to a lower incidence of postoperative hyperkalaemia. MRA should be considered standard treatment for patients awaiting surgery for PA.

Does Preoperative Estimated Glomerular Filtration Rate (eGFR) Predict Short-Term Surgical Outcomes in Patients Undergoing Pancreatic Resections?

IntroductionPreoperative eGFR has been found to be a reliable predictor of post-operative outcomes in patients with normal creatinine levels who undergo surgery. The aim of our study was to evaluate the impact of preoperative eGFR levels on short-term post-operative outcomes in patients undergoing pancreatectomy. MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) pancreatectomy file (2014–2017) was queried for all adult patients (age ≥ 18) who underwent pancreatic resection. Patients were stratified into two groups based on their preoperative eGFR (eGFR < 60 mL/min/1.73m2 and eGFR ≥ 60 mL/min/1.73m2). Outcome measures included post-operative pancreatic fistula, discharge disposition, hospital length of stay, 30-day readmission rate, and 30-day morbidity and mortality. Multivariate logistic regression analysis was performed. ResultsA total of 21,148 were included in the study of which 12% (n = 2256) had preoperative eGFR < 60 mL/min/1.73m2. Patients in the eGFR < 60 group had prolonged length of stay, were less likely to be discharged home, had higher minor and major complication rates, and higher rates of mortality. On logistic regression analysis, lower preoperative eGFR (< 60 mL/min/1.73m2) was associated with higher odds of prolonged length of stay [aOR: 1.294 (1.166–1.436)], adverse discharge disposition [aOR: 1.860 (1.644–2.103)], minor [aOR: 1.460 (1.321–1.613)] and major complications [aOR: 1.214 (1.086–1.358)], bleeding requiring transfusion [aOR: 1.861 (1.656–2.091)], and mortality [aOR: 2.064 (1.523–2.797)]. ConclusionPreoperative decreased renal function measured by eGFR is associated with adverse outcomes in patients undergoing pancreatic resection. The results of this study may be valuable in improving preoperative risk stratification and post-operative expectations.

Clinical Impact of Subclinical Interstitial Fibrosis or Tubular Atrophy in 1-Hour Allograft Biopsy for Remnant Renal Function in Living Kidney Donors: A Prospective Observational Study

Preservation of remnant renal function (RRF) is one of the major concerns among living kidney donors (LKDs). A comprehensive assessment is needed to predict the RRF. In this prospective study, we investigated the roles of histologic findings from a 1-hour allograft biopsy in predicting the RRF. Our prospective study included 116 LKDs who underwent donor nephrectomy (DN) at our institute. Clinical and radiographic data were obtained from their medical charts. Renal volume parameters were calculated using the preoperative computed tomographic images in the volume analyzer SYNAPSE VINCENT image analysis system. Tissues obtained from allograft biopsy were examined. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN. Of 116 LKDs, 95 were finally evaluated. The median age of the LKDs at DN and the preoperative eGFR were 57 years and 80.0 mL/min/1.73 m2, respectively. In the histologic analysis, 68 allografts (71.6%) had nonspecific findings involving the glomerulus, vessel, and tubulointerstitium. Interstitial fibrosis or tubular atrophy (IF/TA) was the only significant predictive factor for RRF (P=.039). No significant association was found between renal volume parameters and IF/TA, whereas remnant renal volume adjusted by body weight (RRV/BW) tended to be relatively correlated with IF/TA (P=.072). Furthermore, LKDs with subclinical IF/TA tended to have decreased RRV/BW compared with those without subclinical IF/TA (P=.088). Our findings suggested that the presence of IF/TA could be a predictive factor for RRF after DN. Further research establishing the predictive model for RRF is warranted to improve the outcomes of LKDs.

Preoperative versus Postoperative Compensation of the Contralateral Normal Kidney in Patients Treated with Radical Nephrectomy for Renal Cell Carcinoma.

Background: We sought to identify the factors affecting renal compensatory processes that occur preoperatively as well as postoperatively in patients treated with radical nephrectomy (RNx) for renal cell carcinoma (RCC). Methods: We retrospectively reviewed the records of 906 patients treated with RNx for RCC. We defined the early compensatory process (process 1) as compensatory adaptation of the contralateral normal kidney (CNK) before RNx. We defined the late compensatory process (process 2) as compensatory adaptation of the CNK after RNx. Total compensation was defined as the combination of these two processes. Multivariable logistic regression analyses were used to identify significant factors associated with processes 1, 2 and total compensation. Results: Mean preoperative, 1-week, and 5-year postoperative estimated glomerular filtration rates (eGFR) were 84.5, 57.6 and 63.7 mL/min/1.73 m2, respectively. Female sex (p < 0.001), lower body mass index (BMI) (p < 0.001), absence of hypertension (p = 0.019), lower preoperative eGFR (p < 0.001), larger tumor volume (p < 0.001), and larger CNK volume (p < 0.001) were significantly associated with process 1. Younger age (p = 0.019), higher BMI (p < 0.001), and absence of diabetes mellitus (DM) (p = 0.033) were significantly associated with process 2. Female sex (p < 0.001), younger age (p < 0.001), absence of DM (p = 0.002), lower preoperative eGFR (p < 0.001), and larger tumor (p = 0.001) and CNK volumes (p < 0.001) were significantly associated with total compensation. Conclusions: Different factors affected each compensatory process. Process 1 made a greater contribution to the entire renal compensatory process than process 2.

Statin Use and Association with Postoperative Estimated Glomerular Filtration Rates in Patients Undergoing Robot-Assisted Partial Nephrectomy.

Objective: To evaluate the association between preoperative statin use with changes in estimated glomerular filtration rate (eGFR) after robot-assisted partial nephrectomy (RAPN). Methods: Three hundred eighty-nine consecutive patients undergoing RAPN were evaluated. Associations of preoperative statin use with change in eGFR from pre-RAPN to postoperative day 1 (POD1), 1, 6, and 12 months after RAPN were evaluated using longitudinal mixed-effects regression models with random patient-specific intercepts and slopes while accounting for imbalance of preoperative patient and tumor characteristics between groups with stabilized inverse propensity score weighting. Postoperative eGFR change from baseline was measured as total change, maintaining eGFR within 10% of baseline, and as going from eGFR >60 mL/min/1.73 m2 to <60 mL/min/1.73 m2. Results: One hundred sixty-seven (43.0%) of 389 patients were on statin therapy preoperatively. Statin patients were older (66 vs 58 years) and had higher rates of comorbidities, including diabetes mellitus (31.7% vs 14.9%) and hypertension (82.6% vs 45%). Statin patients tended to have lower preoperative eGFR (mean ± standard deviation, 71.1 ± 17.6 vs 77.4 ± 19.4 mL/min/1.73 m2). There was no evidence of an association of preoperative statin use with changes in eGFR at any time point after RAPN (p = 0.66). Conclusion: Patients on preoperative statins undergoing RAPN had lower eGFR preoperatively compared with those not taking those medications. There was no evidence of an association between preoperative statin use and change in post-RAPN eGFR in the immediate postoperative period or at 1 year after surgery.

1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series

Abstract Introduction Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Method Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate). Results The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients. Conclusions We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.

MP59-06 LONGITUDINAL CHANGE OF RENAL PARENCHYMAL VOLUME PRESERVED AFTER PARTIAL NEPHRECTOMY IN PATIENTS WITH PREEXISTING CHRONIC KIDNEY DISEASE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-06 LONGITUDINAL CHANGE OF RENAL PARENCHYMAL VOLUME PRESERVED AFTER PARTIAL NEPHRECTOMY IN PATIENTS WITH PREEXISTING CHRONIC KIDNEY DISEASE Masaki Warabino, Hajime Tanaka, Shohei Fukuda, Hiroshi Fukushima, Sho Uehera, Yosuke Yasuda, Soichiro Yoshida, Minato Yokoyama, Yoh Matsuoka, and Yasuhisa Fujii Masaki WarabinoMasaki Warabino More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hiroshi FukushimaHiroshi Fukushima More articles by this author , Sho UeheraSho Uehera More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Functional outcomes after partial nephrectomy (PN) depend on the ipsilateral (ipsi-) renal parenchymal volume (RPV) preserved. New-baseline RPV early after PN has been widely studied; however, a longitudinal change of RPV beyond the new baseline has not been well examined. In this study, we investigated the annual change of eGFR after PN as well as ipsi-RPV in comparison to the contralateral (contra-) RPV in patients with preexisting chronic kidney disease (CKD). METHODS: 76 patients with preoperative eGFR <60 mL/min/1.73m2 who received PN for an unilateral primary renal tumor were analyzed. Patients with solitary kidney, metastatic disease, or renal recurrences developed after PN were excluded. Ipsi- and contra-RPVs before/after PN were measured on CT images. %RPV was defined as RPV after PN normalized by that before PN. The new baseline was defined as 6-12 months after PN and the annual changes of eGFR and %RPVs after the new baseline were assessed using linear mixed model. RESULTS: Median age was 66 and 60 patients (76%) were male. 48 (63%), 11 (15%), and 8 (11%) had hypertension, diabetes, and cardiovascular diseases, respectively. Median tumor size was 2.6 cm and R.E.N.A.L. was 7. Acute kidney injury (AKI) occurred in 13 patients (17%) after PN. Median follow-up was 4.6 years. Median eGFR was 53.2 before PN; it decreased to 50.7 at the new baseline and gradually declined at -0.99/year (95%CI: -1.21, -0.77) afterward. Median ipsi- and contra-RPVs before PN were 124 cm3 and 129 cm3, respectively. After PN, median %ipsi-RPV was 81% at the new baseline and declined at -1.05%/year (95%-CI: -1.31, -0.79) afterward, while %contra-RPV declined at -0.72%/year (-1.05, -0.37). The decrease of %ipsi-RPV from the new baseline to the last follow-up was larger than %contra-RPV (median, -4.2% vs. -1.2%; p=0.001). In multivariable analysis, cardiovascular diseases, larger tumor size, and AKI after PN were associated with a significant decrease of %ipsi-RPV from the new baseline. CONCLUSIONS: In patients with preexisting CKD, eGFR and RPVs gradually declined from the new baseline after PN. The longitudinal decrease of RPV was more pronounced in the operated kidney, which could be affected by cardiovascular morbidities and the extent of surgical manipulation during PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1031-e1032 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masaki Warabino More articles by this author Hajime Tanaka More articles by this author Shohei Fukuda More articles by this author Hiroshi Fukushima More articles by this author Sho Uehera More articles by this author Yosuke Yasuda More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Yoh Matsuoka More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Loading ...

MP49-20 SUTURELESS TECHNIQUE IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY: RESULTS FROM A PROPENSITY-SCORE MATCHED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-20 SUTURELESS TECHNIQUE IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY: RESULTS FROM A PROPENSITY-SCORE MATCHED ANALYSIS Giuseppe Rosiello, Rui Farinha, Artur Paludo, Elio Mazzone, Stefano Puliatti, Marco Amato, Carlo Bravi, Ruben De Groote, Pietro Piazza, Camille Berquin, Francesco Montorsi, Peter Schatteman, Geert De Naeyer, Frederiek D’hondt, and Alexandre Mottrie Giuseppe RosielloGiuseppe Rosiello More articles by this author , Rui FarinhaRui Farinha More articles by this author , Artur PaludoArtur Paludo More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Marco AmatoMarco Amato More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Camille BerquinCamille Berquin More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D’hondtFrederiek D’hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) for treatment of renal mass is gaining momentum. Despite efforts aimed at preserving renal function, the functional decline after RAPN is not negligible. Based on the risk of intraparenchymal vessels injuries during renorrhaphy, with consequently loss of functional renal parenchyma, we aimed at comparing perioperative outcomes of patients undergoing sutureless RAPN (suRAPN) vs. standard RAPN (stRAPN). METHODS: Ninety-two consecutive patients treated with RAPN for clinically localized renal mass (cT1-2) from January 2019 and June 2020 by a single surgeon were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. Specifically, the matched cohorts of suRAPN and stRAPN patients were balanced according to covariates, including age at surgery, preoperative eGFR, clinical tumor size, tumor complexity, defined according to PADUA score, and any individual PADUA item. Chi-square test, t-test and Kruskal-Wallis test examined differences on perioperative outcomes between suRAPN vs. stRAPN patients. RESULTS: Overall, twenty-nine (31%) patients were treated with suRAPN. After 1:1 propensity-score matching, no residual differences remained between the two groups. Only one suRAPN patient experienced intraoperative complications(p=0.9), namely venus bleeding during hilar dissection. Two (6.9%) suRAPN vs. four (13.8%) stRAPN patients experienced 30-day postoperative complications (p=0.3). Operative time (110 vs. 150 min; p<0.01), and length of stay(2 vs. 3 days; p=0.02) were shorter in suRAPN vs. stRAPN patients. TRIFECTA outcomes were achieved in twenty-five (86%) suRAPN vs. twenty (70%) stRAPN patients. Finally, only one (3.4%) suRAPN vs. five (17%) stRAPN patients experienced postoperative AKI. CONCLUSIONS: Sutureless technique in RAPN is a feasible and safe procedure, which demonstrates similar rates of intra- andpostoperative complications compared to the standard technique. Moreover, performing suRAPN may ensure lowerimpact surgery, as demonstrated by shorter operative time and length of stay. Despite promising results on TRIFECTAand functional outcomes are shown, prospective, randomized, trials relying on a larger cohort of patients with longerfollow-up are needed to further assess the impact of sutureless technique on long-term renal function. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e884-e884 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Rosiello More articles by this author Rui Farinha More articles by this author Artur Paludo More articles by this author Elio Mazzone More articles by this author Stefano Puliatti More articles by this author Marco Amato More articles by this author Carlo Bravi More articles by this author Ruben De Groote More articles by this author Pietro Piazza More articles by this author Camille Berquin More articles by this author Francesco Montorsi More articles by this author Peter Schatteman More articles by this author Geert De Naeyer More articles by this author Frederiek D’hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Loading ...

MP42-14 UPSTAGING OF CHRONIC KIDNEY DISEASE AFTER PARTIAL AND RADICAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-14 UPSTAGING OF CHRONIC KIDNEY DISEASE AFTER PARTIAL AND RADICAL NEPHRECTOMY Cameron Britton, Christine Lohse, Abhinav Khanna, Vidit Sharma, John Cheville, Stephen Boorjian, Bradley Leibovich, H. Robert Thompson, and Aaron Potretzke Cameron BrittonCameron Britton More articles by this author , Christine LohseChristine Lohse More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Vidit SharmaVidit Sharma More articles by this author , John ChevilleJohn Cheville More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , H. Robert ThompsonH. Robert Thompson More articles by this author , and Aaron PotretzkeAaron Potretzke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is generally preferred over radical nephrectomy (RN) when technically feasible. Nephron-sparing surgery may be particularly important for patients with chronic kidney disease (CKD). There is sparse literature comparing the outcomes of PN and RN in patients with CKD. We aim to illustrate the degree of renal functional change between PN and RN based on baseline renal function. METHODS: Adults treated with PN or RN for unilateral, sporadic, solid renal masses between 1980 and 2018 were identified. Patients who underwent PN or RN for a solitary kidney, were on dialysis at the time of surgery, or had stage 5 CKD at the time of surgery were excluded. Outcomes included positive margins, 30-day complications, and postoperative renal function assessed by CKD upstaging and percent change in eGFR at 3 months and 1 year following surgery compared to preoperative eGFR. Comparisons of outcomes were evaluated using chi-square, Fisher exact, and Wilcoxon rank sum tests. RESULTS: Amongst a total of 6,912 patients, 2,751 (40%) underwent PN and 4,161 (60%) underwent RN; 70 (2.5%) PNs and 99 (2.4%) RNs resulted in positive surgical margins (p=0.7); 164 (6%) PNs and 209 (5%) RNs resulted in Clavien grade 3 or higher complications. There were 3,471 and 3,256 patients with a 3-month and 1-year postoperative eGFR available for analysis. The interactions between type of surgery and CKD stage in models to predict CKD upstaging and percent change in eGFR were statistically significant (p <0.001 for all), indicating that the association of type of surgery with these outcomes differed by baseline CKD stage; as such, associations of type of surgery with 3-month and 1-year CKD upstaging and percent change in eGFR were stratified by CKD stage (Table). CONCLUSIONS: Patients with preoperative CKD stages 1-3 who underwent PN had significantly less renal functional decline at 3-months and 1-year as assessed by CKD upstaging and percent change in eGFR when compared to patients who underwent RN. There was no significant difference in renal functional outcomes in patients with baseline CKD stage 4, possibly reflecting a selection bias. Patients with stage 3 CKD, in particular, should be counseled regarding the reduced risk of CKD progression with PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e777-e777 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cameron Britton More articles by this author Christine Lohse More articles by this author Abhinav Khanna More articles by this author Vidit Sharma More articles by this author John Cheville More articles by this author Stephen Boorjian More articles by this author Bradley Leibovich More articles by this author H. Robert Thompson More articles by this author Aaron Potretzke More articles by this author Expand All Advertisement PDF DownloadLoading ...

Short- and Mid-Term Impact of Tobacco Smoking on Donor Renal Function Following Living Kidney Donation at a Tertiary Referral Hospital.

The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Risk stratification of anastomotic leakage using eGFR and FIB-4 index in patients undergoing esophageal cancer surgery

Renal insufficiency and liver cirrhosis are identified as independent risk factors for anastomotic leakage (AL) after esophagectomy. However, research evaluating the incidence of AL using quantitative data to measure renal function and liver fibrosis remain to be limited. Therefore, this study was conducted to evaluate postoperative AL after esophagectomy using estimated glomerular filtration rate (eGFR) and fibrosis-4 (FIB-4) index. In total, 184 patients who underwent esophagectomy were included in this study; then, they were divided into the non-AL group (n = 161) and AL group (n = 23), after which their background data and intraoperative and postoperative outcomes were compared. In addition, risk factors for AL were evaluated using a logistic regression model. Preoperative body mass index of ≥21.5kg/m2, hemoglobin A1c level of ≥7.3%, FIB-4 index of ≥1.44, and eGFR of <59ml/min/1.73m2 were found to be significantly frequent in the AL group compared with the non-AL group. Multivariate analysis revealed FIB-4 index of ≥1.44 (p = 0.013; OR, 3.780; 95% CI, 1.320-10.800) and eGFR of <59ml/min/1.73m2 (p = 0.018; OR, 3.110; 95% CI, 1.220-8.020) as the independent risk factors for AL. In addition, we stratified the patients into three groups based on the incidence of AL as follows: low risk (5.5%, low FIB-4 index), intermediate risk (13.0%, high FIB-4 index and eGFR), and high risk (37.5%, high FIB-4 index and low eGFR). Preoperative eGFR and FIB-4 index were found to be useful markers to predict AL after esophagectomy.

Factors Influencing Early Serum Uric Acid Fluctuation After Bariatric Surgery in Patients with Hyperuricemia.

In the short-term after bariatric surgery, the incidence of gout flare was increased. Patients with hyperuricemia are among the high-risk group of postoperative gout attacks. The drastic fluctuation of uric acid is a risk factor for gout flare. This study aimed to explore factors that influenced the magnitudes of serum uric acid (sUA) fluctuation post-surgery in patients with hyperuricemia. One hundred and sixty-five patients with preoperative hyperuricemia undergoing bariatric surgery were reviewed. Pre- and postoperative parameters were collected at baseline and each follow-up point. Univariable and multiple linear regression analyses were performed to explore independent factors that influenced the magnitudes of sUA change. The sUA significantly declined from 489.4 ± 93.7 to 372.6 ± 101.4 μmmol/L in 1 day after surgery, then increased to 531.6 ± 175.5 μmmol/L at 1-month follow-up, and then dropped to 415.2 ± 105.6 and 396.5 ± 114.2 μmmol/L at 3-month and 6-month follow-up, respectively. Preoperative estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), magnesium (Mg), sex, and the change of zinc concentration during the first month are significantly related to magnitudes of sUA fluctuation in the short-term post-surgery period. Multiple linear regression analyses showed preoperative eGFR and HbA1c independently influenced the magnitudes of sUA change at 1 day after surgery; sex, the change of zinc concentration, and HbA1c at 1-month follow-up independently influenced the magnitudes of sUA change at 1-month follow-up. Preoperative eGFR, HbA1c, sex, and the change of zinc concentration postoperative are independent factors affecting the magnitude of the fluctuation. Large-scale studies are warranted to support these findings.

Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?

The impact of warm ischemia time (WIT) on renal functional recovery remains controversial. We examined the length of WIT>30 min on the long-term renal function following on-clamp partial nephrectomy (PN). Data from 23 centers for patients undergoing on-clamp PN between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/min/1.73m2. Patients were divided into two groups according to WIT length: group I "WIT≤30 min" and group II "WIT>30 min." A propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared eGFR values, eGFR (%) preservation, eGFR decline, events of chronic kidney disease (CKD) upgrading, and CKD-free progression rates between both groups. Cox regression analysis evaluated WIT impact on upgrading of CKD stages. The primary cohort consisted of 3526 patients: group I (N.=2868) and group II (N.=658). After matching the final cohort consisted of 344 patients in each group. At last follow-up, there were no significant differences in median eGFR values at 1, 3, 5, and 10 years (P>0.05) between the matched groups. In addition, the median eGFR (%) preservation and absolute eGFR change were similar (89% in group I vs. 87% in group II, P=0.638) and (-10 in group I vs. -11 in group II, P=0.577), respectively. The 5 years new-onset CKD-free progression rates were comparable in the non-matched groups (79% in group I vs. 81% in group II, log-rank, P=0.763) and the matched groups (78.8% in group I vs. 76.3% in group II, log-rank, P=0.905). Univariable Cox regression analysis showed that WIT>30 min was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, P=0.764) nor upgrading into CKD stage ≥III (HR:0.972, 95%CI 0.805-1.173, P=0.764). Retrospective design is a limitation of our study. Our analysis based on a large multicenter international cohort study suggests that WIT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR≥60 mL/min/1.73m2.

Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture.

The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer's exact and analysis of variance testing. The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs (p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 (p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90-120 (p < 0.001). This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.