The impact of intraoperative bleeding on the risk of chronic kidney disease after nephron-sparing surgery.

Published on Jul 1, 2021in World Journal of Urology4.226
· DOI :10.1007/S00345-020-03504-5
Giuseppe Rosiello8
Estimated H-index: 8
(UniSR: Vita-Salute San Raffaele University),
Alessandro Larcher31
Estimated H-index: 31
(UniSR: Vita-Salute San Raffaele University)
+ 11 AuthorsUmberto Capitanio63
Estimated H-index: 63
(UniSR: Vita-Salute San Raffaele University)
PURPOSE The current literature regarding the effect of blood loss (eBL) after nephron-sparing surgery (NSS) on long-term renal function is scarce. We tested the effect of eBL on the risk of developing chronic kidney disease (CKD) after NSS. METHODS Within an institutional prospectively maintained database, we identified 215 patients treated with NSS for cT1N0M0 renal mass at one European high-volume center. Multivariable logistic regression models tested the effect of eBL on the risk of developing CKD, after accounting for surgical complexity, individual clinical characteristics, and surgical experience. Multivariable linear regression models identified predictors of eBL. RESULTS After a median follow-up of 36 months, 55 (25.6%) patients experienced CKD after surgery. At multivariable analyses, eBL independently predicted higher risk of CKD after NSS (odds ratio [OR]: 1.16; 95% confidence intervals [CI] 1.04-1.30; p < 0.01). Specifically, the relationship between eBL and probability of CKD emerged as nonlinear, with a plateau from 0 to 500 mL of eBL and an increase afterward. When multivariable linear regression analyses investigated predictors of eBL, hypertension (Est: 127, 95% CI 12-242; p = 0.03), clinical size (Est: 47, 95% CI 7-87; p = 0.02), and PADUA score (Est: 42; 95% CI 4-80 p = 0.03) achieved independent predictor status for higher intraoperative eBL. Conversely, surgical experience was associated with lower eBL (p = 0.01). CONCLUSIONS Intraoperative bleeding is independently associated with the risk of developing CKD after surgery, even after adjustment for well-known predictors of renal failure and tumor complexity. Hence, strategies aimed at maximally reducing such adverse events deserve special consideration.
#1Julia Mühlbauer (Heidelberg University)H-Index: 3
#2Johannes de Gilde (Heidelberg University)H-Index: 1
Last. Maximilian C. Kriegmair (Heidelberg University)H-Index: 16
view all 9 authors...
INTRODUCTION The aim was to evaluate the impact of perioperative blood transfusions (PBTs) on renal function after surgery for renal cell carcinoma (RCC). METHODS Consecutive patients with RCC who underwent partial nephrectomy or radical nephrectomy between 2005 and 2015 at a tertiary care center were included. Minimum follow-up period was 6 months. A PBT was defined as the transfusion of packed erythrocyte concentrate (EC) within 7 days before until 30 days after surgery. The multivariable anal...
#1Malin Nientiedt (Heidelberg University)H-Index: 3
#2Riccardo Bertolo (Cleveland Clinic)H-Index: 27
Last. Maximillian Christian Kriegmair (Heidelberg University)H-Index: 1
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Abstract Background Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF). Patients & Methods Patients who underwent PN with a preoperative eGFR >60 ml/min/1.73m2 were retrospectively examined at 8 European urological centres. The occurrence of new onset CKD ≥ stage III aft...
#1Umberto Capitanio (UniSR: Vita-Salute San Raffaele University)H-Index: 63
#2Alessandro Larcher (UniSR: Vita-Salute San Raffaele University)H-Index: 31
Last. Roberto Bertini (UniSR: Vita-Salute San Raffaele University)H-Index: 32
view all 19 authors...
Abstract Background Despite better renal function following nephron-sparing surgery (NSS) relative to radical nephrectomy (RN), there is no consensus with respect to the long-term sequelae associated with surgery. Objective To investigate the effect of surgery and the temporal pattern of two different cardiovascular event (CVe) categories after NSS versus RN. Design, setting, and participants We collected data of 898 patients with cT1–2 N0 M0 renal mass and no history of CVe treated with NSS ver...
Partial nephrectomy represents the gold standard treatment for cT1 renal masses (1,2). Indeed, several studies demonstrated the superiority of nephron-sparing approach relative to radical approach, with respect to long-term renal function (3,4). Despite the lack of experimental data, multiple observational investigations described important clinical consequences related to such functional benefit. For example, the clinical sequelae of such benefit range from lower cardiovascular morbidity to pot...
#7Peter Wiklund (Karolinska University Hospital)H-Index: 55
Abstract Background No validated training program for robot-assisted partial nephrectomy (RAPN) exists. Objective To define the structure and provide a pilot clinical validation of a curriculum for robot-assisted partial nephrectomy (RAPN). Design, setting, and participants A modified Delphi consensus methodology involving 27 experts defined curriculum structure. One trainee completed the curriculum under the mentorship of an expert. A total of 40 patients treated with curriculum RAPN (cRAPN) we...
#2K. Bensalah (University of Rennes)H-Index: 48
Abstract Context Despite the improvement in renal cell carcinoma (RCC) diagnosis and management observed during the last 2 decades, RCC remains one of the most lethal urological malignancies. With the expansion of routine imaging for many disorders, an increasing number of patients who harbour RCC are identified incidentally. Objective To summarise and compare RCC incidence and mortality rates, analyse the magnitude of risk factors, and interpret these epidemiological observations in the context...
Abstract Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of ...
#1Wei Liu (Capital Medical University)H-Index: 11
#2Ziwei Xi (Capital Medical University)H-Index: 4
Last. Zhenxian Yan (Capital Medical University)H-Index: 7
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Background: Patients with perioperative bleeding during cardiac surgery are susceptible to acute kidney injury (AKI) which is proposed to be associated with short-term and long-term risk of adverse events. The relationship between perioperative bleeding in off-pump coronary artery bypass grafting (OPCAB) and AKI remains unknown. The purpose of this study is to evaluate the impact of perioperative bleeding on the risk of postoperative AKI in patient undergoing OPCAB. Methods: Perioperative major ...
#2A. AlbinarrateH-Index: 3
Last. B. BarrachinaH-Index: 5
view all 3 authors...
BACKGROUND:Various different interventions can be used to reduce surgical blood loss; however, there is no “gold standard” for accurately measuring the volume of perioperative blood loss, and this makes it difficult to assess the efficacy of these interventions.METHODS:We used data from a previous m
#6S.M. Bagshaw (U of A: University of Alberta)H-Index: 52
Acute kidney injury (AKI) and chronic kidney disease are increasingly recognized as interconnected entities and the term acute kidney disease (AKD) has been proposed to define ongoing pathophysiologic processes following an episode of AKI. In this Consensus statement, the Acute Disease Quality Initiative 16 Workgroup propose definitions and staging criteria for AKD, and strategies for the management of affected patients. They also make recommendations for areas of future research with the aims o...
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