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96 Ischemia effect on kidney function after partial nephrectomy
96
Ischemia effect on kidney function after partial nephrectomy Eur Urol Suppl 2014;13;e96
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Voylenko O., Stakhovskyi O., Vitruk I., Kotov V., Stakhovsky E. National Cancer Institute, Dept. of Oncourology, Kyiv, Ukraine INTRODUCTION & OBJECTIVES: Central ischemia is a standard approach to control bleeding during partial nephrectomy (PN). Ishcemia leeds to irreversible structural changes that result in decrease and loss of kidney function with further development of chronic kidney disease (CKD). The objective of this study was to analyse ischemia effect during PN on kidney function in long postoperative period. MATERIAL & METHODS: Prospective randomized trial was initiated in our department to study the effect of ischemia on kidney function during PN. After randomization all the patients underwent PN: In first group 87 (50,9 %) patients had PN with no ischemia and in control group of 84 (49,1%) cases ischemia was used during the procedure. Mean patients age was 54,3±11,8 and 54,9±11,5 years in mentioned groups respectively. Both groups were equal in male/female distribution (55,2 % and 44,8 % versus 47,6 % and 52,4 % respectively). Mean size of the tumor was 42,0±22,1 versus 46,8±26,2 mm; overall GFR 91,3±20,6 versus 91,2±21,0 ml/min; ECOG status 0,54±0,48 versus 0,5±0,45 for main and control groups respectively. RESULTS:
Ischemia significantly decreased intraoperative blood loss from 397,7±236,9 ml to 332,7±162,3ml ,(р < 0,05). Overall and split GFR on the tumor side are presented in diagram 1. Overall GFR in control group decreased significantly 3 months postoperatively from 91,2±21,0 to 77,2±15,4 ml/min (р < 0,05) and recovered to 86,8±18,9 ml/min after 12 months of follow up. In group without ischemia overall GFR did not show significant change with time, 91,3±20,7 ml/min, 89,8±16,3 ml/min and 93,0±16,1 ml/min respectively. Analysis of split GFR on effected side showed sigificant decrease in GFR from 44,3±12,4 ml/min baseline to 31,4±10,2ml/min in 3 months (р < 0,05) and partial recovery till 35,7±11,4 ml/min in 1 year. In main group GFR values in effected kidney did not change in time significantly 43,9±10,2 ml/min, 39,1±10,2 ml/min and 41,8±7,2 ml/min respectively at baseline, 3 and 12 months postoperatively. CONCLUSIONS: PN with ischemia results in significant decrease of overall and split GFR of the kidney harbouring the tumor (р < 0,05). No significant difference was seen in GFR in patients without ischemia. Avoiding ischemia during PN may prevent development of CKD. Further studies needed to validate our findings.
Ischemia effect on kidney function after partial nephrectomy Eur Urol Suppl 2014;13;e96
Print! Print!
Voylenko O., Stakhovskyi O., Vitruk I., Kotov V., Stakhovsky E. National Cancer Institute, Dept. of Oncourology, Kyiv, Ukraine INTRODUCTION & OBJECTIVES: Central ischemia is a standard approach to control bleeding during partial nephrectomy (PN). Ishcemia leeds to irreversible structural changes that result in decrease and loss of kidney function with further development of chronic kidney disease (CKD). The objective of this study was to analyse ischemia effect during PN on kidney function in long postoperative period. MATERIAL & METHODS: Prospective randomized trial was initiated in our department to study the effect of ischemia on kidney function during PN. After randomization all the patients underwent PN: In first group 87 (50,9 %) patients had PN with no ischemia and in control group of 84 (49,1%) cases ischemia was used during the procedure. Mean patients age was 54,3±11,8 and 54,9±11,5 years in mentioned groups respectively. Both groups were equal in male/female distribution (55,2 % and 44,8 % versus 47,6 % and 52,4 % respectively). Mean size of the tumor was 42,0±22,1 versus 46,8±26,2 mm; overall GFR 91,3±20,6 versus 91,2±21,0 ml/min; ECOG status 0,54±0,48 versus 0,5±0,45 for main and control groups respectively. RESULTS:
Ischemia significantly decreased intraoperative blood loss from 397,7±236,9 ml to 332,7±162,3ml ,(р < 0,05). Overall and split GFR on the tumor side are presented in diagram 1. Overall GFR in control group decreased significantly 3 months postoperatively from 91,2±21,0 to 77,2±15,4 ml/min (р < 0,05) and recovered to 86,8±18,9 ml/min after 12 months of follow up. In group without ischemia overall GFR did not show significant change with time, 91,3±20,7 ml/min, 89,8±16,3 ml/min and 93,0±16,1 ml/min respectively. Analysis of split GFR on effected side showed sigificant decrease in GFR from 44,3±12,4 ml/min baseline to 31,4±10,2ml/min in 3 months (р < 0,05) and partial recovery till 35,7±11,4 ml/min in 1 year. In main group GFR values in effected kidney did not change in time significantly 43,9±10,2 ml/min, 39,1±10,2 ml/min and 41,8±7,2 ml/min respectively at baseline, 3 and 12 months postoperatively. CONCLUSIONS: PN with ischemia results in significant decrease of overall and split GFR of the kidney harbouring the tumor (р < 0,05). No significant difference was seen in GFR in patients without ischemia. Avoiding ischemia during PN may prevent development of CKD. Further studies needed to validate our findings.