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819 RENAL FUNCTION RECOVERY AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY
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THE JOURNAL OF UROLOGY姞
Vol. 183, No. 4, Supplement, Monday, May 31, 2010
Source of Funding: None
819 RENAL FUNCTION RECOVERY AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY Ari Adamy*, Ricardo Lima Favaretto, Daher C. Chade, Lucas Nogueira, Caroline Savage, Paul Russo, Jonathan Coleman, Bertrand Guillonneau, Karim Touijer, New York, NY Source of Funding: None
818 CHRONIC KIDNEY DISEASE PRIOR AND FOLLOWING NEPHRON-SPARING SURGERY Melanie Clark, Sergey Shikanov*, Chicago, IL; Jay Raman, Benjamin Smith, Matthew Kaag, Hershey, PA; Paul Russo, New York, NY; Jeffrey C. Wheat, J Stuart Wolf Jr, Ann Arbor, MI; Surena Matin, Houston, TX; William Huang, New York, NY; Arieh Shalhav, Scott E. Eggener, Chicago, IL INTRODUCTION AND OBJECTIVES: We performed a multiinstitutional retrospective cohort study to evaluate baseline renal function of patients who underwent partial nephrectomy for renal tumors and determine rates of progression to higher stages of chronic kidney disease (CKD). METHODS: Preoperative and postoperative serum creatinine values were obtained from patients who underwent partial nephrectomy at six institutions with a normal contralateral kidney and had baseline CKD of I (GFR ⬎ 90 ml/min/1.73m2), II (GFR ⫽ 60 – 89 ml/min/1.73m2), or III (GFR ⫽ 30 – 59 ml/min/1.73m2). Patients with baseline CKD IV and V were excluded. The Modification of Diet in Renal Disease Study (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine CKD stage. The endpoint was change in CKD at long-term follow-up (3–18 months). A multivariate logistic regression model tested the association of newly acquired CKD III with age, sex, race, BMI, surgical approach, hypertension, diabetes, coronary artery disease, tumor size and margins, renal vessel clamping, ischemia time, hypothermia, and estimated blood loss. RESULTS: A total of 1,228 patients underwent partial nephrectomy with follow-up creatinine data at least 3 months following surgery. Mean baseline GFR was 75 ml/min/1.73m2. At baseline, 19% of patients had CKD I, 59% had CKD II, and 22% had CKD III. At long-term follow-up, mean post-operative GFR for patients with baseline CKD I or II was 71 ml/min/1.73m2 with 280 (29%) patients newly entering CKD III. Increasing age (OR ⫽ 1.05, p ⬍0.001), female gender (OR ⫽ 1.80 p ⫽ 0.002), increasing tumor size (OR ⫽ 1.20, p ⫽ 0.003), clamping the renal artery and vein (B ⫽ 2.28, p ⫽ 0.054), and lower pre-operative GFR (OR ⫽ 1.05, p ⬍0.001) were independently associated with newly acquired CKD III. The presence of co-morbid conditions did not independently predict increased risk of a higher CKD stage. CONCLUSIONS: Approximately one-quarter of patients presenting for partial nephrectomy with a normal contralateral kidney have stage III CKD and an additional 29% will develop CKD III or higher following surgery. Increasing age, female gender, larger tumor size, clamping the artery and vein, and lower baseline GFR are associated with worsening kidney function following surgery.
INTRODUCTION AND OBJECTIVES: The aim of the study is evaluate how renal function changed over time after partial nephrectomy (PN) and determine whether the association between renal function and time after surgery differed for those treated by laparoscopic or open PN. METHODS: 987 patients were treated by PN between January 2002 and July 2009. eGFR was calculated using the abbreviated Modification of Diet in Renal Disease formula. We created a multivariable generalized estimating equations linear model that predicted eGFR based on the time from surgery, preoperative eGFR, tumor size, ASA score, and ischemia time. To test whether the recovery of renal function differed by approach we included an interaction term between time from surgery and approach in the model. RESULTS: In total, 182 patients underwent laparoscopic PN and 805 underwent open PN. No statistically significant difference was observed between the laparoscopic and open PN patients with regards to: age (59 vs. 61 years, respectively p⫽0.8), tumor size (2.5 cm vs. 2.9 cm, respectively, p⫽1) and ischemia time (35 min vs. 39 min, respectively). The baseline preoperative eGFR however, was slightly lower in the laparoscopic group (67 vs. 72, respectively, p⬍0.001). In a multivariable model that included an interaction term between time from surgery and approach, the interaction term was significant (p⫽0.005), indicating that there was evidence of a differential effect of recovery of renal function over time by approach; however, this affect appears to be small (Figure). For example, the predicted eGFR for an average patient 2 months after PN was 65 and 62 ml/min/1.73m2 for those treated by laparoscopic and open PN; at 6 months the respective predicted eGFR values were 67 and 62 ml/min/1.73m2. CONCLUSIONS: The surgical approach appears to independently affect the recovery of renal function after partial nephrectomy. Laparoscopically treated patients maintained a slightly higher renal function.
Source of Funding: None
THE JOURNAL OF UROLOGY姞
Vol. 183, No. 4, Supplement, Monday, May 31, 2010
Source of Funding: None
819 RENAL FUNCTION RECOVERY AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY Ari Adamy*, Ricardo Lima Favaretto, Daher C. Chade, Lucas Nogueira, Caroline Savage, Paul Russo, Jonathan Coleman, Bertrand Guillonneau, Karim Touijer, New York, NY Source of Funding: None
818 CHRONIC KIDNEY DISEASE PRIOR AND FOLLOWING NEPHRON-SPARING SURGERY Melanie Clark, Sergey Shikanov*, Chicago, IL; Jay Raman, Benjamin Smith, Matthew Kaag, Hershey, PA; Paul Russo, New York, NY; Jeffrey C. Wheat, J Stuart Wolf Jr, Ann Arbor, MI; Surena Matin, Houston, TX; William Huang, New York, NY; Arieh Shalhav, Scott E. Eggener, Chicago, IL INTRODUCTION AND OBJECTIVES: We performed a multiinstitutional retrospective cohort study to evaluate baseline renal function of patients who underwent partial nephrectomy for renal tumors and determine rates of progression to higher stages of chronic kidney disease (CKD). METHODS: Preoperative and postoperative serum creatinine values were obtained from patients who underwent partial nephrectomy at six institutions with a normal contralateral kidney and had baseline CKD of I (GFR ⬎ 90 ml/min/1.73m2), II (GFR ⫽ 60 – 89 ml/min/1.73m2), or III (GFR ⫽ 30 – 59 ml/min/1.73m2). Patients with baseline CKD IV and V were excluded. The Modification of Diet in Renal Disease Study (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine CKD stage. The endpoint was change in CKD at long-term follow-up (3–18 months). A multivariate logistic regression model tested the association of newly acquired CKD III with age, sex, race, BMI, surgical approach, hypertension, diabetes, coronary artery disease, tumor size and margins, renal vessel clamping, ischemia time, hypothermia, and estimated blood loss. RESULTS: A total of 1,228 patients underwent partial nephrectomy with follow-up creatinine data at least 3 months following surgery. Mean baseline GFR was 75 ml/min/1.73m2. At baseline, 19% of patients had CKD I, 59% had CKD II, and 22% had CKD III. At long-term follow-up, mean post-operative GFR for patients with baseline CKD I or II was 71 ml/min/1.73m2 with 280 (29%) patients newly entering CKD III. Increasing age (OR ⫽ 1.05, p ⬍0.001), female gender (OR ⫽ 1.80 p ⫽ 0.002), increasing tumor size (OR ⫽ 1.20, p ⫽ 0.003), clamping the renal artery and vein (B ⫽ 2.28, p ⫽ 0.054), and lower pre-operative GFR (OR ⫽ 1.05, p ⬍0.001) were independently associated with newly acquired CKD III. The presence of co-morbid conditions did not independently predict increased risk of a higher CKD stage. CONCLUSIONS: Approximately one-quarter of patients presenting for partial nephrectomy with a normal contralateral kidney have stage III CKD and an additional 29% will develop CKD III or higher following surgery. Increasing age, female gender, larger tumor size, clamping the artery and vein, and lower baseline GFR are associated with worsening kidney function following surgery.
INTRODUCTION AND OBJECTIVES: The aim of the study is evaluate how renal function changed over time after partial nephrectomy (PN) and determine whether the association between renal function and time after surgery differed for those treated by laparoscopic or open PN. METHODS: 987 patients were treated by PN between January 2002 and July 2009. eGFR was calculated using the abbreviated Modification of Diet in Renal Disease formula. We created a multivariable generalized estimating equations linear model that predicted eGFR based on the time from surgery, preoperative eGFR, tumor size, ASA score, and ischemia time. To test whether the recovery of renal function differed by approach we included an interaction term between time from surgery and approach in the model. RESULTS: In total, 182 patients underwent laparoscopic PN and 805 underwent open PN. No statistically significant difference was observed between the laparoscopic and open PN patients with regards to: age (59 vs. 61 years, respectively p⫽0.8), tumor size (2.5 cm vs. 2.9 cm, respectively, p⫽1) and ischemia time (35 min vs. 39 min, respectively). The baseline preoperative eGFR however, was slightly lower in the laparoscopic group (67 vs. 72, respectively, p⬍0.001). In a multivariable model that included an interaction term between time from surgery and approach, the interaction term was significant (p⫽0.005), indicating that there was evidence of a differential effect of recovery of renal function over time by approach; however, this affect appears to be small (Figure). For example, the predicted eGFR for an average patient 2 months after PN was 65 and 62 ml/min/1.73m2 for those treated by laparoscopic and open PN; at 6 months the respective predicted eGFR values were 67 and 62 ml/min/1.73m2. CONCLUSIONS: The surgical approach appears to independently affect the recovery of renal function after partial nephrectomy. Laparoscopically treated patients maintained a slightly higher renal function.
Source of Funding: None