Do patients with Stage 3–5 chronic kidney disease benefit from ischaemia-sparing techniques during partial nephrectomy?

Alp Tuna Beksac, Kennedy E. Okhawere, Daniel C. Rosen, Amr Elbakry, Bheesham D. Dayal, Jorge Daza, John P. Sfakianos, Abaza Ronney, Daniel D. Eun, Akshay Bhandari, Ashok K. Hemal, James Porter, Michael D. Stifelman, Ketan K. Badani

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective: To analyse whether selective arterial clamping (SAC) and off-clamp (OC) techniques during robot-assisted partial nephrectomy (RPN) are associated with a renal functional benefit in patients with Stage 3–5 chronic kidney disease (CKD). Patients and methods: The change in estimated glomerular filtration rate (eGFR) over time was compared between 462 patients with baseline CKD 3–5 that underwent RPN with main arterial clamping (MAC) (n = 375, 81.2%), SAC (n = 48, 10.4%) or OC (n = 39, 8.4%) using a multivariable linear mixed-effects model. All follow-up eGFRs, including baseline and follow-up between 3 and 24 months, were included in the model for analysis. The median follow-up was 12.0 months (interquartile range 6.7–16.5; range 3.0–24.0 months). Results: In the multivariable linear mixed-effects model adjusting for characteristics including tumour size and the R.E.N.A.L. (Radius; Exophytic/Endophytic; Nearness; Anterior/Posterior; Location) Nephrometry Score, the change in eGFR over time was not significantly different between SAC and MAC RPN (β = −1.20, 95% confidence interval [CI] −5.45, 3.06; P = 0.582) and OC and MAC RPN (β = −1.57, 95% CI −5.21, 2.08; P = 0.400). Only 20 (15 MAC, two SAC, three OC) patients overall had progression of their CKD stage at last follow-up. The mean ischaemia time was 17 min for MAC and 15 min for SAC. There was no benefit to SAC or OC in terms of blood loss, perioperative complications, length of stay, or surgical margins. Conclusion: SAC and OC techniques during RPN were not associated with benefit in preservation of eGFR in patients with baseline CKD.

Original languageEnglish
Pages (from-to)442-448
Number of pages7
JournalBJU International
Volume125
Issue number3
DOIs
StatePublished - 1 Mar 2020

Keywords

  • chronic kidney disease
  • functional outcome
  • glomerular filtration rate
  • off-clamping
  • partial nephrectomy
  • selective clamping

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