Partial nephrectomy (PN) is the reference standard for renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain poorly defined.
Single center, retrospective analysis of 841 RMSK patients (1975-2022) managed with PN with functional data, including 361/435/45 with cold/warm/zero ischemia, respectively.
A total of 155 of these patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery-from-ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Logistic regression identified predictive factors for AKI and predictors of Rec-Ischemia were analyzed by multivariable linear regression.
Overall, median preoperative GFR was 56.7 ml/min/1.73m2 and new-baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, a primary focus of this study, median warm (n = 70)/cold (n = 85) ischemia times were 25/34 minutes, respectively; and median preoperative, new-baseline and 5-year GFRs were 57.8, 45.0, and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.84, p < 0.001). Parenchymal volume loss accounted for 69% of the total median GFR decline associated with PN, leaving only 3 to 4 ml/min/1.73m2 attributed to ischemia and other factors. AKI occurred in 52% of patients and the only independent predictor of AKI was ischemia time. Independent predictors of reduced Rec-Ischemia were increased age, warm ischemia, and AKI.
The main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type/duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required.
Urologic oncology. 2023 Dec 22 [Epub ahead of print]
Worapat Attawettayanon, Yosuke Yasuda, Jj H Zhang, Nityam Rathi, Carlos Munoz-Lopez, Akira Kazama, Kieran Lewis, Ben Ponvilawan, Snehi Shah, Andrew Wood, Jianbo Li, João Pedro Emrich Accioly, Rebecca A Campbell, Joseph Zabell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Christopher Weight, Steven C Campbell
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Tokyo Medical and Dental University, Graduate School, Tokyo, Japan., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan., Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH., Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH., Department of Urology, University of Minnesota, Minneapolis, MN., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38142208