Risk Factors of Chronic Kidney Disease after Partial Nephrectomy
Background: In comparison with radical nephrectomy, partial nephrectomy (PN) is considered a better option for small renal mass surgery, because of optimal kidney tissue removal and parenchyma preservation. But there are patients with worsening postoperative renal function (RF) and chronic kidney d...
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| Format: | Article |
| Language: | English |
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Vilnius University Press
2022-12-01
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| Series: | Acta Medica Lituanica |
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| Online Access: | https://www.journals.vu.lt/AML/article/view/29633 |
| _version_ | 1811201202742886400 |
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| author | Jurijus Makevičius Beata Kirstukaitė Renata Komiagienė Arūnas Želvys Feliksas Jankevičius Marius Miglinas |
| author_facet | Jurijus Makevičius Beata Kirstukaitė Renata Komiagienė Arūnas Želvys Feliksas Jankevičius Marius Miglinas |
| author_sort | Jurijus Makevičius |
| collection | DOAJ |
| description |
Background: In comparison with radical nephrectomy, partial nephrectomy (PN) is considered a better option for small renal mass surgery, because of optimal kidney tissue removal and parenchyma preservation. But there are patients with worsening postoperative renal function (RF) and chronic kidney disease (CKD) after PN. Therefore, the study aimed to evaluate and detect risk factors for CKD after PN.
Materials and Methods. A prospective observational study was conducted, which consisted of 91 individuals who received PN with warm ischemia and an estimated preoperative glomerular filtration rate (eGFR) ≥ 60 ml/min/1.72m2 without pathologic albuminuria. Preoperative and intraoperative factors like intraoperative hypotension (IOH), blood loss, and resected part volume were analyzed.
Results. At 6-month follow-up, 14 (15.4 %) patients experienced postoperative CKD. After 12 months of follow-up, 15 (16.5 %) patients had CKD. Patients with CKD had a lower preoperative eGFR than non-CKD group (69.0 vs 91.0 ml/min/1.72m2, p < 0.001), longer ischemia (20.0 vs 14.0, p = 0.002) and IOH time (40.0 (40.0; 47.5) vs 0.0 (0.0; 26.2) min, p < 0.001). Also, higher volumes of resected kidney part tumor and removed parenchyma with higher glomerulosclerosis amounts (73.3 % vs 14.5 %, p = 0.009) were found in CKD group. Estimated blood loss > 500 ml during PN was discovered to be the major risk factor for CKD development (OR 11.13, 95 % CI 1.88–65.92, p = 0.008). Furthermore, kidney resected part volume (OR 1.05, 95% CI 1.05-1.10, p = 0.033) and IOH time (OR 1.11, 95% CI 1.03-1.19, p = 0.005) were identified as risk factors for postoperative CKD.
Conclusions. Patients after PN are at an increased risk of CKD development. Most commonly, postoperative CKD occurs in the first 6 months after PN and appears stable after 12 months of follow-up. Blood loss > 500 ml during PN, IOH and resected kidney volume can have an impact on postoperative RF and increase the risk of CKD.
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| first_indexed | 2024-04-12T02:17:00Z |
| format | Article |
| id | doaj.art-ae3bf731325f422ab5f3d73030b88757 |
| institution | Directory Open Access Journal |
| issn | 1392-0138 2029-4174 |
| language | English |
| last_indexed | 2024-04-12T02:17:00Z |
| publishDate | 2022-12-01 |
| publisher | Vilnius University Press |
| record_format | Article |
| series | Acta Medica Lituanica |
| spelling | doaj.art-ae3bf731325f422ab5f3d73030b887572022-12-22T03:52:13ZengVilnius University PressActa Medica Lituanica1392-01382029-41742022-12-0129210.15388/Amed.2022.29.2.18Risk Factors of Chronic Kidney Disease after Partial NephrectomyJurijus Makevičius0Beata Kirstukaitė1Renata Komiagienė2Arūnas Želvys3Feliksas Jankevičius4Marius Miglinas5Institute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, LithuaniaFaculty of Medicine, Vilnius University, Vilnius, LithuaniaInstitute of Biomedical Sciences, Faculty of Medicine, Department of Radiology, Nuclear Medicine and Physics of Medicine, Vilnius University, Vilnius, LithuaniaInstitute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, LithuaniaInstitute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, LithuaniaInstitute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius, Lithuania Background: In comparison with radical nephrectomy, partial nephrectomy (PN) is considered a better option for small renal mass surgery, because of optimal kidney tissue removal and parenchyma preservation. But there are patients with worsening postoperative renal function (RF) and chronic kidney disease (CKD) after PN. Therefore, the study aimed to evaluate and detect risk factors for CKD after PN. Materials and Methods. A prospective observational study was conducted, which consisted of 91 individuals who received PN with warm ischemia and an estimated preoperative glomerular filtration rate (eGFR) ≥ 60 ml/min/1.72m2 without pathologic albuminuria. Preoperative and intraoperative factors like intraoperative hypotension (IOH), blood loss, and resected part volume were analyzed. Results. At 6-month follow-up, 14 (15.4 %) patients experienced postoperative CKD. After 12 months of follow-up, 15 (16.5 %) patients had CKD. Patients with CKD had a lower preoperative eGFR than non-CKD group (69.0 vs 91.0 ml/min/1.72m2, p < 0.001), longer ischemia (20.0 vs 14.0, p = 0.002) and IOH time (40.0 (40.0; 47.5) vs 0.0 (0.0; 26.2) min, p < 0.001). Also, higher volumes of resected kidney part tumor and removed parenchyma with higher glomerulosclerosis amounts (73.3 % vs 14.5 %, p = 0.009) were found in CKD group. Estimated blood loss > 500 ml during PN was discovered to be the major risk factor for CKD development (OR 11.13, 95 % CI 1.88–65.92, p = 0.008). Furthermore, kidney resected part volume (OR 1.05, 95% CI 1.05-1.10, p = 0.033) and IOH time (OR 1.11, 95% CI 1.03-1.19, p = 0.005) were identified as risk factors for postoperative CKD. Conclusions. Patients after PN are at an increased risk of CKD development. Most commonly, postoperative CKD occurs in the first 6 months after PN and appears stable after 12 months of follow-up. Blood loss > 500 ml during PN, IOH and resected kidney volume can have an impact on postoperative RF and increase the risk of CKD. https://www.journals.vu.lt/AML/article/view/29633chronic kidney diseasepartial nephrectomyrisk factorsintraoperative hypotensionblood loss |
| spellingShingle | Jurijus Makevičius Beata Kirstukaitė Renata Komiagienė Arūnas Želvys Feliksas Jankevičius Marius Miglinas Risk Factors of Chronic Kidney Disease after Partial Nephrectomy Acta Medica Lituanica chronic kidney disease partial nephrectomy risk factors intraoperative hypotension blood loss |
| title | Risk Factors of Chronic Kidney Disease after Partial Nephrectomy |
| title_full | Risk Factors of Chronic Kidney Disease after Partial Nephrectomy |
| title_fullStr | Risk Factors of Chronic Kidney Disease after Partial Nephrectomy |
| title_full_unstemmed | Risk Factors of Chronic Kidney Disease after Partial Nephrectomy |
| title_short | Risk Factors of Chronic Kidney Disease after Partial Nephrectomy |
| title_sort | risk factors of chronic kidney disease after partial nephrectomy |
| topic | chronic kidney disease partial nephrectomy risk factors intraoperative hypotension blood loss |
| url | https://www.journals.vu.lt/AML/article/view/29633 |
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