Renal Function After Partial Nephrectomy: A Comparative Analysis of Warm, Cold, and No Ischemia Methods.

Area of Science:

• Nephrology
• Urology
• Surgical Outcomes

Background:

• Contradictory evidence exists regarding the impact of renal ischemia during partial nephrectomy (PN) on renal functional outcomes.
• Limited data are available for large cohorts of patients undergoing PN without ischemia.

Purpose of the Study:

• To evaluate the effect of the use and type of renal ischemia during PN on renal functional outcomes.
• To assess long-term changes in glomerular filtration rate (GFR) and split function after PN.

Main Methods:

• Retrospective review of 742 patients undergoing PN.
• Patients were divided into four cohorts: no ischemia, cold ischemia, and warm ischemia time (WIT) ≤ 30 minutes or > 30 minutes.
• Twelve-month relative GFR changes and split function were assessed using univariate and multivariable regression analyses.

Main Results:

• No significant difference in mean relative GFR decrease at 3 or 12 months was observed among the four cohorts.
• The type or duration of renal ischemia was not associated with 12-month GFR changes.
• Predictors of decreased 12-month GFR included older age, higher estimated blood loss, lower baseline GFR, more tumors resected, and postoperative acute kidney injury.

Conclusions:

• The use and type of renal ischemia during PN affect short-term, but not long-term, renal functional outcomes.
• Facilities proficient in various ischemia techniques may benefit complex PN cases.