Initial Experience with Sodium Acetate as a Renoprotective Agent During Robotic Partial Nephrectomy.

Area of Science:

• Nephrology
• Urology
• Surgical Innovation

Background:

• Animal studies suggest sodium acetate activates hypoxia-inducible factor pathways, offering protection against acute kidney injury (AKI).
• Clinical data on sodium acetate's renoprotective effects during partial nephrectomy are limited.
• Robotic partial nephrectomy carries a risk of perioperative kidney injury.

Purpose of the Study:

• To evaluate the clinical efficacy of intraoperative sodium acetate infusion (SAI) as a renoprotective agent.
• To assess the impact of SAI on acute kidney injury (AKI) rates in patients undergoing robotic partial nephrectomy.
• To investigate potential benefits in patients with pre-existing chronic kidney disease (CKD).

Main Methods:

• Retrospective review of a single surgeon's experience with intraoperative SAI during partial nephrectomies.
• Primary outcomes measured were rates of AKI using KDIGO and RIFLE criteria.
• Propensity score matching and logistic regression analysis were employed to assess the association between SAI and AKI.

Main Results:

• Overall, SAI did not significantly alter postoperative renal function (serum creatinine, GFR).
• Intraoperative SAI was associated with a trend towards lower odds of AKI on postoperative day 1 (RIFLE: p=0.06; KDIGO: p=0.05).
• In patients with pre-existing CKD, SAI was significantly associated with lower AKI rates (RIFLE: p=0.01; KDIGO: p<0.05).

Conclusions:

• Perioperative SAI did not demonstrate a statistically significant renoprotective effect in all patients undergoing partial nephrectomy.
• SAI may reduce postoperative AKI risk, especially in patients with pre-existing CKD.
• Further research is needed to clarify the clinical impact of sodium acetate for renoprotection.