Renal Function After Partial Nephrectomy: Effect of Warm Ischemia Relative to Quantity and Quality of Preserved Kidney
Renal Function After Partial Nephrectomy: Effect of Warm Ischemia Relative to Quantity and Quality of Preserved Kidney
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DOI：
10.1016/j.urology.2011.10.031
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发表时间：
2012-02-01
期刊：
影响因子：
2.1
通讯作者：
Campbell, Steven C.
中科院分区：
文献类型：
--
作者：
Thompson, R. Houston;Lane, Brian R.;Campbell, Steven C.
目的探讨肾部分切除术（PN）后热缺血时间（WIT）及保留肾的数量和质量对肾功能恢复的影响。WIT相对于这些其他参数的影响最近受到了挑战。方法我们确定了362例连续的孤立肾患者接受了PN使用热缺血。采用多变量模型和多重插补来评估急性肾功能衰竭和新发IV期慢性肾脏病（CKD）的相关性。（范围4 - 55），保留肾脏的中位百分比为80%术前肾小球滤过率（GFR）中位数为61 mL/min/1.73 m2（范围11 - 133）。术后发生急性肾功能衰竭70例（19%）。在226例术前GFR> 30 mL/min/1.73 m 2的患者中，38例（17%）在随访期间新发IV期CKD。在多变量分析中，WIT（P = 0.021）、肾脏保留百分比（P = 0.009）和术前GFR（P <0.001）与急性肾功能衰竭显著相关，仅肾脏保留百分比（P <0.001）和术前GFR（P <0.001）与随访期间新发IV期CKD显著相关。使用我们先前发表的25分钟的临界点，在调整数量和质量因素的多变量分析中，WIT> 25分钟与新发IV期CKD显著相关（风险比2.27，P = 0.049）。结论我们的研究结果验证了肾脏的质量和数量是PN后肾功能的最重要决定因素。此外，我们还证明了WIT仍然是与短期和长期肾功能相关的重要可改变特征。手术的精确性，最大限度地保留，血管化的实质的量，应该是优化PN程序的研究重点。泌尿学79：356 - 360，2012年。(C)2012 Elsevier Inc.
OBJECTIVE To evaluate the effects of warm ischemia time (WIT) and quantity and quality of kidney preserved on renal functional recovery after partial nephrectomy (PN). The effect of WIT relative to these other parameters has recently been challenged.METHODS We identified 362 consecutive patients with a solitary kidney who had undergone PN using warm ischemia. Multivariate models with multiple imputations were used to evaluate the associations with acute renal failure and new-onset stage IV chronic kidney disease (CKD).RESULTS The median WIT was 21 minutes (range 4-55), the median percentage of kidney preserved was 80% (range 25%-98%), and the median preoperative glomerular filtration rate (GFR) was 61 mL/min/1.73 m(2) (range 11-133). Postoperative acute renal failure occurred in 70 patients (19%). Of the 226 patients with a preoperative GFR >30 mL/min/1.73 m(2), 38 (17%) developed new-onset stage IV CKD during follow-up. On multivariate analysis, the WIT (P = .021), percentage of kidney preserved (P = .009), and preoperative GFR (P < .001) were significantly associated with acute renal failure, and only the percentage of kidney preserved (P < .001) and preoperative GFR (P < .001) were significantly associated with new-onset stage IV CKD during follow-up. Using our previously published cutpoint of 25 minutes, a WIT of >25 minutes remained significantly associated with new-onset stage IV CKD in a multivariate analysis adjusting for the quantity and quality factors (hazard ratio 2.27, P = .049).CONCLUSION Our results have validated that the quality and quantity of kidney are the most important determinants of renal function after PN. In addition, we have also demonstrated that the WIT remains an important modifiable feature associated with short- and long-term renal function. The precision of surgery, maximizing the amount of preserved, vascularized parenchyma, should be a focus of study for optimizing the PN procedure. UROLOGY 79: 356-360, 2012. (C) 2012 Elsevier Inc.