Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function

Zabell, Joseph; Isharwal, Sudhir; Dong, Wen; Abraham, Joseph R; Wu, Jitao; Suk-Ouichai, Chalairat; Palacios, Diego Aguilar; Remer, Erick M.; Li, Jianbo; Campbell, Steven C.

doi:10.1016/j.juro.2018.07.042

Cited by 44 publications

(47 citation statements)

References 25 publications

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“…Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2)(3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours.…”

Section: Resultsmentioning

confidence: 99%

“…We used these variables to construct a Introduction According to the latest AUA guidelines, partial nephrectomy (PN) should be preferred over radical nephrectomy (RN) for localised tumours, regardless of the surgical approach [1]. In fact, PN has comparable oncological outcomes with better preservation of renal function and a lower rate of long-term cardiovascular events compared to RN [2,3]. Nevertheless, PN is a technical challenging procedure.…”

Section: Resultsmentioning

confidence: 99%

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Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

et al. 2019

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nomogram for predicting the risk of postoperative surgical complications. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of >5%. ConclusionSeveral clinical predictors have been associated with postoperative surgical complications after PN. We used this information to develop and internally validate a nomogram to predict such risk.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

et al. 2019

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“…Despite being the largest study of patients with RAPN in a solitary kidney, the sample size of 72 was relatively small and limits the overall generalizability of the results. Furthermore, we used the incidence of AKI as a measure of the degree to which SAC vs MAC impaired renal function, but it has been suggested that AKI after partial nephrectomy is not a strong indicator of long‐term function [19], in which case other measures of renal function, ranging from renal biopsy to Diethylenetriamine Pentaacetic Acid or an inulin‐like test, may provide more clarity. Possible confounders to renal impairment, including the pneumo level and the amount of normal parenchyma resected, were not considered because of a lack of recorded data.…”

Section: Discussionmentioning

confidence: 99%

Selective clamping during robot‐assisted partial nephrectomy in patients with a solitary kidney: is it safe and does it help?

Badani¹,

Kothari

Okhawere³

et al. 2020

BJU International

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ObjectivesTo obtain the most accurate assessment of the risks and benefits of selective clamping in robot-assisted partial nephrectomy (RAPN) we evaluated outcomes of this technique vs those of full clamping in patients with a solitary kidney undergoing RAPN. Patients and MethodsData from institutional review board-approved retrospective and prospective databases from 2006 to 2019 at multiple institutions with sharing agreements were evaluated. Patients with a solitary kidney were identified and stratified based on whether selective or full renal artery clamping was performed. Both groups were analysed with regard to demographics, risk factors, intra-operative complications, and postoperative outcomes using chi-squared tests, Fisher's exact tests, t-tests and Mann-Whitney U-tests. ResultsOur initial cohort consisted of 4112 patients, of whom 72 had undergone RAPN in a solitary kidney (51 with full clamping and 21 with selective clamping). There were no significant differences in demographics, tumour size, baseline estimated glomerular filtration rate (eGFR), or warm ischaemia time (WIT) between the groups (Table 1). Intra-operative outcomes, including estimated blood loss, operating time, and intra-operative complications were similar in the two groups. Short-and long-term postoperative percentage change in eGFR, frequency of acute kidney injury (AKI), and frequency of de novo chronic kidney disease (CKD) were also not significantly different between the two techniques. ConclusionIn a large cohort of patients with solitary kidney undergoing RAPN, selective clamping resulted in similar intra-operative and postoperative outcomes compared to full clamping and conferred no additional risk of harm. However, selective clamping did not appear to provide any functional advantage over full clamping as there was no difference observed in the frequency of AKI, CKD or change in eGFR. Short WIT in both groups (<15 min) may have prevented identification of benefits in the selective clamping group; a similar study analysing cases with longer WIT may elucidate any beneficial effects of selective clamping.

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“…Secondary outcomes included the long-term functional change ratio (FCR) of GFR, which was defined as the most recent GFR/new baseline GFR after surgery [6]. New baseline GFR was defined as the latest value available during 3-12 months after surgery considering that renal function recovers after the initial drop immediately after surgery.…”

Section: Patient Data and Outcome Measurementsmentioning

confidence: 99%

“…As such, although a few previous studies have reported the association between AKI after nephrectomy and the risk of development of postoperative CKD, most studies analyzed a relatively small number of patients with different outcome definitions and used inadequate statistical analyses for the time-to-event outcome. As the appropriate statistical analyses were not selected, the linear relationship of the AKI stages with long-term renal functional change [6] or the graded association of AKI stages with CKD have not been evaluated. Therefore, we conducted a retrospective study evaluating the graded association of AKI stages with new-onset CKD and the linear association of AKI stages with renal functional change ratio from new-baseline renal function after radical nephrectomy to assess whether the association of AKI and CKD after radical nephrectomy is robust and has a dose-response relationship.…”

Section: Introductionmentioning

confidence: 99%

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Shin

Jang

et al. 2020

JCM

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The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

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Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function

Cited by 44 publications

References 25 publications

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

Selective clamping during robot‐assisted partial nephrectomy in patients with a solitary kidney: is it safe and does it help?

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

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