Mp56-15 Clinical Characteristics of Patients With Renal Cancer Do Impact More Than Ischemia Time on Post-Operative Renal Function

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-15 CLINICAL CHARACTERISTICS OF PATIENTS WITH RENAL CANCER DO IMPACT MORE THAN ISCHEMIA TIME ON POST-OPERATIVE RENAL FUNCTION Giuseppe Rosiello, Giacomo Musso, Chiara Re, Francesco Cei, Federico Belladelli, Francesco Trevisani, Daniele Cignoli, Giuseppe Basile, Lucia Salerno, Alessandro Bertini, Isaline Rowe, Annamaria Ferrara, Elio Mazzone, Giorgio Gandaglia, Roberto Bertini, Francesco Montorsi, Andrea Salonia, Alessandro Larcher, and Umberto Capitanio Giuseppe RosielloGiuseppe Rosiello , Giacomo MussoGiacomo Musso , Chiara ReChiara Re , Francesco CeiFrancesco Cei , Federico BelladelliFederico Belladelli , Francesco TrevisaniFrancesco Trevisani , Daniele CignoliDaniele Cignoli , Giuseppe BasileGiuseppe Basile , Lucia SalernoLucia Salerno , Alessandro BertiniAlessandro Bertini , Isaline RoweIsaline Rowe , Annamaria FerraraAnnamaria Ferrara , Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Roberto BertiniRoberto Bertini , Francesco MontorsiFrancesco Montorsi , Andrea SaloniaAndrea Salonia , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of warm ischemia time (WIT) on renal function recovery after partial nephrectomy (PN) is still debated. We aimed at quantifying the weighted effect of ischemia time vs. preoperative clinical risk factors, namely hypertension, smoking status and diabetes. METHODS: Within a prospectively maintained database, we identified 1,100 patients treated with PN at a single European high-volume center (2000–2022). Only patients with estimated glomerular filtration rate (eGFR)>=60 mL/min/1.73 m3 were included. Acute kidney injury was defined according to the RIFLE criteria. Multivariable logistic regression analyses estimated the risk of AKI after surgery according to each preoperative clinical risk factor and their combinations. A local polynomial smoother weighted function was used to graphically explore the risk of AKI according to preoperative risk factors and WIT. Covariates were age at surgery, preoperative eGFR, Charlson Comorbidity Index, ischemia time, estimated blood loss, and surgical approach (open vs. robotic). RESULTS: Overall, 86 patients (7.8%) had diabetes, 397 (36%) hypertension and 415 (38%) were currently or former smoker. Median age at surgery was 59 Interquartile range (IQR): 50-67 years. Median clinical tumor size was 3.1 (IQR: 2.5-4.1) cm. Overall, 480 (44%) vs. 273 (25%) vs. 43 (4%) had 1 vs. 2 vs. 3 preoperative risk factors. After adjusting for several confounders, presence of 1 Odds ratio (OR): 1.34; p=0.01 vs. 2 (OR: 1.85; p<0.001) vs. 3 (OR: 2.35; p=0.02) risk factors was associated with a significantly increased risk of AKI. The impact of WIT on postoperative AKI differed accordingly with the number of preoperative risk factors (Figure 1). CONCLUSIONS: WIT in patients undergoing PN does not seem to have an impact on short-term kidney function, namely postoperative AKI, in absence of preoperative clinical risk factors. Conversely, the combination of risk factors increases the detrimental effect of WIT on renal function after surgery. Referral to nephrologist should be considered in presence of clinical risk factors, especially in complex cases, where a prolonged ischemia time is foreseen. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e932 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe Rosiello More articles by this author Giacomo Musso More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Federico Belladelli More articles by this author Francesco Trevisani More articles by this author Daniele Cignoli More articles by this author Giuseppe Basile More articles by this author Lucia Salerno More articles by this author Alessandro Bertini More articles by this author Isaline Rowe More articles by this author Annamaria Ferrara More articles by this author Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Roberto Bertini More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...