title: Prospective randomized comparison between cold and warm ischemia in patients with renal insufficiency undergoing partial nephrectomy.
abstract: OBJECTIVE
  To compare between the effects of cold and warm ischemia on the risk of deterioration of renal insufficiency in patients with T1 renal tumor managed by partial nephrectomy.
  
  
  METHODS
  This prospective randomized study was performed on 120 patients with chronic kidney disease, all having T1 renal tumors. Renal function was estimated by estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula. Patients were randomly divided into 2 groups: in group A, warm ischemia was used, and in group B, cold ischemia was used. All patients were treated by open partial nephrectomy. Patients were followed up for 2 years. The primary outcome of the study was eGFR at 2 years. Secondary outcomes were tumor recurrence, loss of follow-up, or patient death.
  
  
  RESULTS
  Mean age of patients was 60.7 ± 5.3 years. Associated chronic disease (diabetes and/or hypertension) was present in 93 patients. Worsening of renal insufficiency occurred within 1 month of surgery in 38 patients (27 in group A and 11 in group B). At 3 months follow-up, 21 of these 38 patients returned to their baseline eGFR. Warm ischemia rendered patients more prone to a decrease in eGFR after partial nephrectomy, with relative risk of 1.34 and 2 times at 3 months and 2 years of follow-up, respectively.
  
  
  CONCLUSIONS
  Warm ischemia increases the risk of deterioration of renal functions in patients with renal insufficiency undergoing open partial nephrectomy for renal tumors.
authors: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Electronic address: h_abdeldaeim@hotmail.com.
authors: Hussein M
authors: HM
authors: Abdeldaeim
authors: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Tamer M
authors: TM
authors: Abou Youssif
authors: Biostatistics Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
authors: Moataza M
authors: MM
authors: Abdel Wahab
authors: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Ahmed F
authors: AF
authors: Kotb
authors: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Omar F
authors: OF
authors: El Gebaly
authors: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Ibrahim A
authors: IA
authors: Mokhless
mesh_terms: D000368:Aged; D050377:Cold Ischemia / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D052096:Warm Ischemia / Q000009:adverse effects*