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Sources of Funding: None

Introduction

To preserve renal function, partial nephrectomy is recommended to patients with small renal masses. However, controversy still exists as to whether prolonged ischemic time adversely affects the incidence of chronic kidney disease. We assessed the effect of prolonged ischemic time to global renal function following partial nephrectomy.

Methods

We reviewed data from 1,588 patients who underwent open or robotic partial nephrectomy for clinical T1 renal tumor with normal renal function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.732). Patients were subjected to group A (ischemic time ≤ 30 minutes) or group B (ischemic time > 30 minutes). Propensity score matching was used to adjust for potential confounders, which resulted in 320 patients in each group. Postoperative renal function was evaluated at the last follow-up visit. Multivariate analysis was used to determine predictors for the newly acquired CKD (eGFR < 60 mL/min/1.732).

Results

In the groups A and B, mean ischemic time was 19.8 and 40.2 minutes respectively. There were no statistically significant differences in other baseline variables between the groups. After a median follow-up of 37 months, mean postoperative eGFR was similar (84.5 vs. 83.2 mL/min/1.732, p = 0.424) and the rate of CKD did not differ in the two groups (6.3% vs. 7.2%, p = 0.636). Prolonged ischemic time did not affect the newly acquired CKD among the open partial nephrectomy subgroup (p = 0.847) and those with robotic partial nephrectomy (p = 0.160). Moreover, dividing ischemic time into five groups (≤ 20, 21-30, 31-40, 41-50, and ≥ 50 minutes) provided no further information on new onset CKD (7.5%, 4.8%, 7.0%, 7.9%, and 6.5%, p = 0.865) compared with the two groups with a cut-off at 30 minutes.

Conclusions

In patients with a normal baseline renal function, prolonged ischemic time is not an independent predictor of CKD following partial nephrectomy.

Funding

None