The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model

Daniel A. Salevitz, Michael W. Patton, Mark D. Tyson, Rafael Nunez-Nateras, Erin N. Ferrigni, Paul E. Andrews, Mitchell R Humphreys, Erik P Castle

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model. Patients and Methods: From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels. Results: There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8-63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: -6.07 mL/min/1.73 m<sup>2</sup> vs OFF-PN: -6.00 mL/min/1.73 m<sup>2</sup>, P=0.69). No differences were noted in the % change in the MAG-3 renal scans (ON-PN: -0.77% vs OFF-PN: -1.1%, P=0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or % change in differential function on renal scan. Conclusions: In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.

Original languageEnglish (US)
Pages (from-to)474-478
Number of pages5
JournalJournal of Endourology
Volume29
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Nephrectomy
Ischemia
Kidney
Glomerular Filtration Rate
Creatinine
Demography

ASJC Scopus subject areas

  • Urology

Cite this

Salevitz, D. A., Patton, M. W., Tyson, M. D., Nunez-Nateras, R., Ferrigni, E. N., Andrews, P. E., ... Castle, E. P. (2015). The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model. Journal of Endourology, 29(4), 474-478. https://doi.org/10.1089/end.2014.0476

The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model. / Salevitz, Daniel A.; Patton, Michael W.; Tyson, Mark D.; Nunez-Nateras, Rafael; Ferrigni, Erin N.; Andrews, Paul E.; Humphreys, Mitchell R; Castle, Erik P.

In: Journal of Endourology, Vol. 29, No. 4, 01.04.2015, p. 474-478.

Research output: Contribution to journalArticle

Salevitz DA, Patton MW, Tyson MD, Nunez-Nateras R, Ferrigni EN, Andrews PE et al. The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model. Journal of Endourology. 2015 Apr 1;29(4):474-478. https://doi.org/10.1089/end.2014.0476
Salevitz, Daniel A. ; Patton, Michael W. ; Tyson, Mark D. ; Nunez-Nateras, Rafael ; Ferrigni, Erin N. ; Andrews, Paul E. ; Humphreys, Mitchell R ; Castle, Erik P. / The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model. In: Journal of Endourology. 2015 ; Vol. 29, No. 4. pp. 474-478.
@article{4b3582b763024ec0a337991550fba33d,
title = "The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model",
abstract = "Purpose: To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model. Patients and Methods: From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels. Results: There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8-63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: -6.07 mL/min/1.73 m2 vs OFF-PN: -6.00 mL/min/1.73 m2, P=0.69). No differences were noted in the {\%} change in the MAG-3 renal scans (ON-PN: -0.77{\%} vs OFF-PN: -1.1{\%}, P=0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or {\%} change in differential function on renal scan. Conclusions: In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.",
author = "Salevitz, {Daniel A.} and Patton, {Michael W.} and Tyson, {Mark D.} and Rafael Nunez-Nateras and Ferrigni, {Erin N.} and Andrews, {Paul E.} and Humphreys, {Mitchell R} and Castle, {Erik P}",
year = "2015",
month = "4",
day = "1",
doi = "10.1089/end.2014.0476",
language = "English (US)",
volume = "29",
pages = "474--478",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "4",

}

TY - JOUR

T1 - The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model

AU - Salevitz, Daniel A.

AU - Patton, Michael W.

AU - Tyson, Mark D.

AU - Nunez-Nateras, Rafael

AU - Ferrigni, Erin N.

AU - Andrews, Paul E.

AU - Humphreys, Mitchell R

AU - Castle, Erik P

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Purpose: To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model. Patients and Methods: From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels. Results: There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8-63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: -6.07 mL/min/1.73 m2 vs OFF-PN: -6.00 mL/min/1.73 m2, P=0.69). No differences were noted in the % change in the MAG-3 renal scans (ON-PN: -0.77% vs OFF-PN: -1.1%, P=0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or % change in differential function on renal scan. Conclusions: In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.

AB - Purpose: To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model. Patients and Methods: From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels. Results: There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8-63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: -6.07 mL/min/1.73 m2 vs OFF-PN: -6.00 mL/min/1.73 m2, P=0.69). No differences were noted in the % change in the MAG-3 renal scans (ON-PN: -0.77% vs OFF-PN: -1.1%, P=0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or % change in differential function on renal scan. Conclusions: In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.

UR - http://www.scopus.com/inward/record.url?scp=84926617084&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926617084&partnerID=8YFLogxK

U2 - 10.1089/end.2014.0476

DO - 10.1089/end.2014.0476

M3 - Article

VL - 29

SP - 474

EP - 478

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 4

ER -