Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy.
OBJECTIVE
To identify independent predictors of renal failure after partial nephrectomy (PN) in patients with renal cell carcinoma (RCC).


METHODS
Data were available for 166 patients with pathological T1-3 N0M0 RCC treated with PN. Renal failure after PN was defined as a decrease in glomerular filtration rate (GFR) of >25% (RIFLE criteria). The GFR before and after PN was estimated using the Modification of Diet in Renal Disease study group equation. Univariable and multivariable logistic regression models were used to assess a decrease of >25% in GFR from the preoperative level. Candidate predictor variables were age, gender, PN indication (absolute vs relative), preoperative GFR, tumour size, perioperative blood loss, surgery duration and clamping time.


RESULTS
After PN, 22 (13.3%) patients had a decrease in GFR of >25%. The perioperative blood loss (P = 0.02), clamping time (P = 0.04) and preoperative GFR (P = 0.002) were independent predictors of a decrease in GFR of >25%.


CONCLUSIONS
We identified two important potentially modifiable variables that should be considered in the planning of PN, i.e. the clamping time and blood loss. It is possible that selective referral to experienced surgeons who can perform PN within short surgical and clamping times, and with minimal blood loss, could minimize the rate of renal failure, especially in patients with an underlying renal function impairment.
Jeldres
Claudio
C
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada.
Bensalah
Karim
K
Capitanio
Umberto
U
Zini
Laurent
L
Perrotte
Paul
P
Suardi
Nazareno
N
Tostain
Jacques
J
Valeri
Antoine
A
Descotes
Jean-Luc
JL
Rambeaud
Jean-Jacques
JJ
de La Taille
Alexandre
A
Salomon
Laurent
L
Abbou
Claude
C
Patard
Jean-Jacques
JJ
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000150:complications; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult