Determinants of renal functional decline after open partial nephrectomy: A comparison of warm, cold, and non-ischemic modalities

Ramzi Jabaji, Kerrin L. Palazzi, Reza Mehrazin, Seth A. Cohen, James H. Masterson, Jason R. Woo, Hak Lee, Michael A. Liss, Ryan Kopp, Song Wang, Sean P. Stroup, Anthony L. Patterson, James O. L'Esperance, Ithaar H. Derweesh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN. Materials and methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non- ischemic techniques. Primary outcome was development of de novo chronic kidney disease (CKD), (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2), at 1 year follow up. Univariate and multivariable analysis (MVA) were performed examining factors associated with ischemia technique and the development of de novo CKD. Results: Median follow up 34.7 months. Two hundred and forty-one patients underwent warm ischemic, 31 cold ischemic, and 75 clampless PN. Patient characteristics were similar between groups. Clampless group had lower mean RENAL scores (6.4) than cold (7.9, p = 0.005) and warm (7, p = 0.037) ischemia groups. Cold ischemia cohort had longer median IT than the warm cohort (50min versus 25 min, p = 0.001). There were no significant differences in proportion of patients developing de novo CKD (warm 14.9%, cold 15%, clampless 8.7%, p = 0.422). MVA demonstrated that neither ischemic modality nor IT ≥ 30 minutes was associated with development of de novo CKD, while RENAL scores of increasing complexity (RENAL score 7-9 OR 4.32, p = 0.003; RENAL score ≥ 10 OR 15.42, p <0.001) were independently associated with de novo CKD. Conclusions: Increasing tumor complexity, as indicated by the RENAL score, was an overriding determinant of post PN renal functional outcome. Prospective investigation is requisite to elucidate risk and protective factors for renal functional degeneration after PN.

Original languageEnglish (US)
Pages (from-to)7126-7133
Number of pages8
JournalCanadian Journal of Urology
Volume21
Issue number1
StatePublished - 2014
Externally publishedYes

Fingerprint

Nephrectomy
Chronic Renal Insufficiency
Kidney
Ischemia
Cold Ischemia
Warm Ischemia
Glomerular Filtration Rate
Neoplasms

Keywords

  • Carcinoma
  • Chronic kidney disease
  • Glomerular filtration rate
  • Ischemia
  • Partial nephrectomy
  • Renal cell
  • RENAL nephrometry

ASJC Scopus subject areas

  • Urology

Cite this

Jabaji, R., Palazzi, K. L., Mehrazin, R., Cohen, S. A., Masterson, J. H., Woo, J. R., ... Derweesh, I. H. (2014). Determinants of renal functional decline after open partial nephrectomy: A comparison of warm, cold, and non-ischemic modalities. Canadian Journal of Urology, 21(1), 7126-7133.

Determinants of renal functional decline after open partial nephrectomy : A comparison of warm, cold, and non-ischemic modalities. / Jabaji, Ramzi; Palazzi, Kerrin L.; Mehrazin, Reza; Cohen, Seth A.; Masterson, James H.; Woo, Jason R.; Lee, Hak; Liss, Michael A.; Kopp, Ryan; Wang, Song; Stroup, Sean P.; Patterson, Anthony L.; L'Esperance, James O.; Derweesh, Ithaar H.

In: Canadian Journal of Urology, Vol. 21, No. 1, 2014, p. 7126-7133.

Research output: Contribution to journalArticle

Jabaji, R, Palazzi, KL, Mehrazin, R, Cohen, SA, Masterson, JH, Woo, JR, Lee, H, Liss, MA, Kopp, R, Wang, S, Stroup, SP, Patterson, AL, L'Esperance, JO & Derweesh, IH 2014, 'Determinants of renal functional decline after open partial nephrectomy: A comparison of warm, cold, and non-ischemic modalities', Canadian Journal of Urology, vol. 21, no. 1, pp. 7126-7133.
Jabaji, Ramzi ; Palazzi, Kerrin L. ; Mehrazin, Reza ; Cohen, Seth A. ; Masterson, James H. ; Woo, Jason R. ; Lee, Hak ; Liss, Michael A. ; Kopp, Ryan ; Wang, Song ; Stroup, Sean P. ; Patterson, Anthony L. ; L'Esperance, James O. ; Derweesh, Ithaar H. / Determinants of renal functional decline after open partial nephrectomy : A comparison of warm, cold, and non-ischemic modalities. In: Canadian Journal of Urology. 2014 ; Vol. 21, No. 1. pp. 7126-7133.
@article{9362f03892924bb995c2681c295c13e1,
title = "Determinants of renal functional decline after open partial nephrectomy: A comparison of warm, cold, and non-ischemic modalities",
abstract = "Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN. Materials and methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non- ischemic techniques. Primary outcome was development of de novo chronic kidney disease (CKD), (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2), at 1 year follow up. Univariate and multivariable analysis (MVA) were performed examining factors associated with ischemia technique and the development of de novo CKD. Results: Median follow up 34.7 months. Two hundred and forty-one patients underwent warm ischemic, 31 cold ischemic, and 75 clampless PN. Patient characteristics were similar between groups. Clampless group had lower mean RENAL scores (6.4) than cold (7.9, p = 0.005) and warm (7, p = 0.037) ischemia groups. Cold ischemia cohort had longer median IT than the warm cohort (50min versus 25 min, p = 0.001). There were no significant differences in proportion of patients developing de novo CKD (warm 14.9{\%}, cold 15{\%}, clampless 8.7{\%}, p = 0.422). MVA demonstrated that neither ischemic modality nor IT ≥ 30 minutes was associated with development of de novo CKD, while RENAL scores of increasing complexity (RENAL score 7-9 OR 4.32, p = 0.003; RENAL score ≥ 10 OR 15.42, p <0.001) were independently associated with de novo CKD. Conclusions: Increasing tumor complexity, as indicated by the RENAL score, was an overriding determinant of post PN renal functional outcome. Prospective investigation is requisite to elucidate risk and protective factors for renal functional degeneration after PN.",
keywords = "Carcinoma, Chronic kidney disease, Glomerular filtration rate, Ischemia, Partial nephrectomy, Renal cell, RENAL nephrometry",
author = "Ramzi Jabaji and Palazzi, {Kerrin L.} and Reza Mehrazin and Cohen, {Seth A.} and Masterson, {James H.} and Woo, {Jason R.} and Hak Lee and Liss, {Michael A.} and Ryan Kopp and Song Wang and Stroup, {Sean P.} and Patterson, {Anthony L.} and L'Esperance, {James O.} and Derweesh, {Ithaar H.}",
year = "2014",
language = "English (US)",
volume = "21",
pages = "7126--7133",
journal = "Canadian Journal of Urology",
issn = "1195-9479",
publisher = "Canadian Journal of Urology",
number = "1",

}

TY - JOUR

T1 - Determinants of renal functional decline after open partial nephrectomy

T2 - A comparison of warm, cold, and non-ischemic modalities

AU - Jabaji, Ramzi

AU - Palazzi, Kerrin L.

AU - Mehrazin, Reza

AU - Cohen, Seth A.

AU - Masterson, James H.

AU - Woo, Jason R.

AU - Lee, Hak

AU - Liss, Michael A.

AU - Kopp, Ryan

AU - Wang, Song

AU - Stroup, Sean P.

AU - Patterson, Anthony L.

AU - L'Esperance, James O.

AU - Derweesh, Ithaar H.

PY - 2014

Y1 - 2014

N2 - Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN. Materials and methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non- ischemic techniques. Primary outcome was development of de novo chronic kidney disease (CKD), (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2), at 1 year follow up. Univariate and multivariable analysis (MVA) were performed examining factors associated with ischemia technique and the development of de novo CKD. Results: Median follow up 34.7 months. Two hundred and forty-one patients underwent warm ischemic, 31 cold ischemic, and 75 clampless PN. Patient characteristics were similar between groups. Clampless group had lower mean RENAL scores (6.4) than cold (7.9, p = 0.005) and warm (7, p = 0.037) ischemia groups. Cold ischemia cohort had longer median IT than the warm cohort (50min versus 25 min, p = 0.001). There were no significant differences in proportion of patients developing de novo CKD (warm 14.9%, cold 15%, clampless 8.7%, p = 0.422). MVA demonstrated that neither ischemic modality nor IT ≥ 30 minutes was associated with development of de novo CKD, while RENAL scores of increasing complexity (RENAL score 7-9 OR 4.32, p = 0.003; RENAL score ≥ 10 OR 15.42, p <0.001) were independently associated with de novo CKD. Conclusions: Increasing tumor complexity, as indicated by the RENAL score, was an overriding determinant of post PN renal functional outcome. Prospective investigation is requisite to elucidate risk and protective factors for renal functional degeneration after PN.

AB - Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN. Materials and methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non- ischemic techniques. Primary outcome was development of de novo chronic kidney disease (CKD), (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2), at 1 year follow up. Univariate and multivariable analysis (MVA) were performed examining factors associated with ischemia technique and the development of de novo CKD. Results: Median follow up 34.7 months. Two hundred and forty-one patients underwent warm ischemic, 31 cold ischemic, and 75 clampless PN. Patient characteristics were similar between groups. Clampless group had lower mean RENAL scores (6.4) than cold (7.9, p = 0.005) and warm (7, p = 0.037) ischemia groups. Cold ischemia cohort had longer median IT than the warm cohort (50min versus 25 min, p = 0.001). There were no significant differences in proportion of patients developing de novo CKD (warm 14.9%, cold 15%, clampless 8.7%, p = 0.422). MVA demonstrated that neither ischemic modality nor IT ≥ 30 minutes was associated with development of de novo CKD, while RENAL scores of increasing complexity (RENAL score 7-9 OR 4.32, p = 0.003; RENAL score ≥ 10 OR 15.42, p <0.001) were independently associated with de novo CKD. Conclusions: Increasing tumor complexity, as indicated by the RENAL score, was an overriding determinant of post PN renal functional outcome. Prospective investigation is requisite to elucidate risk and protective factors for renal functional degeneration after PN.

KW - Carcinoma

KW - Chronic kidney disease

KW - Glomerular filtration rate

KW - Ischemia

KW - Partial nephrectomy

KW - Renal cell

KW - RENAL nephrometry

UR - http://www.scopus.com/inward/record.url?scp=84894085416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894085416&partnerID=8YFLogxK

M3 - Article

C2 - 24529014

AN - SCOPUS:84894085416

VL - 21

SP - 7126

EP - 7133

JO - Canadian Journal of Urology

JF - Canadian Journal of Urology

SN - 1195-9479

IS - 1

ER -