Survival and Functional Stability in Chronic Kidney Disease Due to Surgical Removal of Nephrons: Importance of the New Baseline Glomerular Filtration Rate

Lane, Brian R.; Demirjian, Sevag; Derweesh, Ithaar; Takagi, Toshio; Zhang, Zhiling; Velet, Lily; Ercole, Cesar E.; Fergany, Amr; Campbell, Steven C.

doi:10.1016/j.eururo.2015.04.043

Cited by 179 publications

(138 citation statements)

References 24 publications

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“…As already verified by others [8], baseline medical conditions that may produce renal functional impairment remain the key and most informative causes of renal failure, regardless of all surgical efforts to preserve nephrons [9]. However, our findings also corroborate the beneficial effect of NSS for the consequences of a baseline medical condition favoring chronic kidney disease [9].…”

Section: E U R O P E a N U R O L O G Ysupporting

confidence: 89%

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

et al. 2016

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Section: E U R O P E a N U R O L O G Ysupporting

confidence: 89%

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

et al. 2016

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“…A partial nephrectomy (PN) with preservation of nephrons is recommended in early-stage RCCs restricted to one kidney [2]. Notwithstanding the nephron-sparing effect of PN compared to radical nephrectomy, a postoperative impairment of renal function is common [3,4]. Despite its often transient nature, a clinically significant GFR decrease of 16–30% is observed in the first days following surgery [3–5].…”

Section: Introductionmentioning

confidence: 99%

Renal function following xenon anesthesia for partial nephrectomy—An explorative analysis of a randomized controlled study

et al. 2017

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BackgroundPerioperative preservation of renal function has a significant impact on morbidity and mortality in kidney surgery. Nephroprotective effects of the anesthetic xenon on ischemia-reperfusion injury were found in several experimental studies.ObjectiveWe aimed to explore whether xenon anesthesia can reduce renal damage in humans undergoing partial nephrectomy and to gather pilot data of possible nephroprotection in these patients.DesignA prospective randomized, single-blinded, controlled study.SettingSingle-center, University Hospital of Aachen, Germany between July 2013-October 2015.PatientsForty-six patients with regular renal function undergoing partial nephrectomy.InterventionsPatients were randomly assigned to receive xenon- (n = 23) or isoflurane (n = 23) anesthesia.Main outcome measuresPrimary outcome was the maximum postoperative glomerular filtration rate (GFR) decline within seven days after surgery. Secondary outcomes included intraoperative and tumor-related data, assessment of further kidney injury markers, adverse events and optional determination of renal function after 3–6 months.ResultsUnexpected radical nephrectomy was performed in 5 patients, thus they were excluded from the per-protocol analysis, but included in the intention-to-treat analysis. The maximum postoperative GFR decline was attenuated by 45% in the xenon-group (10.9 ml min-1 1.73 cm-2 versus 19.7 ml min-1 1.73 cm-2 in the isoflurane group), but without significance (P = 0.084). Occurrence of adverse events was reduced (P = 0.003) in the xenon group. Renal function was similar among the groups after 3–6 months.ConclusionXenon anesthesia was feasible and safe in patients undergoing partial nephrectomy with regard to postoperative renal function. We found no significant effect on early renal function but less adverse events in the xenon group. Larger randomized controlled studies in more heterogeneous collectives are required, to confirm or refute the possible clinical benefit on renal function by xenon.Trial registrationClinicalTrials.gov NCT01839084 and EudraCT 2012-005698-30

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“…Non-renal cancer mortality did not differ significantly in patients with no CKD and in those with CKD-S (HR 1.07 95% CI 0.86-1.32, p = 0.5). Interestingly, the new baseline GFR in CKD-S patients remained stable over time, whereas patients with CKD-M/S experienced progressive declines in GFR [14]. This study highlights two important aspects of the debate surrounding PN and RN.…”

Section: Does Pn Really Provide Durable Benefits In Long-term Renal Fmentioning

confidence: 89%

“…However, these data have led investigators to hypothesize that reductions in GFR from a nephrectomy for RCC may not correlate with worse clinical outcomes. Lane et al evaluated this by stratifying patients according to CKD status: no CKD, surgically-induced CKD (CKD-S), and preexisting medical renal disease prior to nephrectomy (CKD-M/S) [14]. Non-renal cancer mortality did not differ significantly in patients with no CKD and in those with CKD-S (HR 1.07 95% CI 0.86-1.32, p = 0.5).…”

Section: Does Pn Really Provide Durable Benefits In Long-term Renal Fmentioning

confidence: 99%

Radical Nephrectomy is the Treatment of Choice for Complex, Localized Renal Tumors

Meissner

McCormick

Matin

et al. 2018

KCA

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Survival and Functional Stability in Chronic Kidney Disease Due to Surgical Removal of Nephrons: Importance of the New Baseline Glomerular Filtration Rate

Cited by 179 publications

References 24 publications

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

Renal function following xenon anesthesia for partial nephrectomy—An explorative analysis of a randomized controlled study

Radical Nephrectomy is the Treatment of Choice for Complex, Localized Renal Tumors

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