title: Minimal effect of cold ischemia time on progression to late-stage chronic kidney disease observed long term after partial nephrectomy.
abstract: OBJECTIVE
  To assess the influence of cold ischemia on postoperative renal function and the new onset of late-stage chronic kidney disease during long-term follow-up after partial nephrectomy.
  
  
  METHODS
  A total of 131 patients with renal tumors who underwent partial nephrectomy and were followed up for >or=12 months were included in the present study. Renal function was analyzed using the estimated glomerular filtration rate (e-GFR).
  
  
  RESULTS
  We classified the subjects into 3 groups according to the length of cold ischemia time: group 1, 1-30 minutes; group 2, 31-60 minutes; and group 3, >60 minutes. Although the postoperative e-GFR was lower in group 3 than in groups 1 and 2, no significant difference was found among the 3 groups during long-term follow-up when preoperative CKD was absent. A cold ischemia time of >or=44 minutes significantly increased the probability of freedom from the new onset of an e-GFR of <45 mL/min/1.73 m(2), but this difference was minimal. Multivariate analysis showed that the preoperative e-GFR and the relative decrease of e-GFR at 1 year after surgery were the significant factors determining postoperative renal function.
  
  
  CONCLUSIONS
  A cold ischemia time of >44 minutes appears to be a threshold influencing the new onset of late-stage CKD; however, it was not a significant factor on multivariate analysis. Thus, renal hypothermia appears to prevent the deterioration of renal function long term after surgery for patients undergoing a longer ischemia time.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Iida
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Amano
authors.forename: Hayakazu
authors.initials: H
authors.lastname: Nakazawa
authors.forename: Fumio
authors.initials: F
authors.lastname: Ito
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050377:Cold Ischemia / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome