Kidney Week

Abstract: SA-PO201

Impact of Ischemia Time on Kidney Function in Patients with Microcirculation Impairment during Partial Nephrectomy (PN) for Kidney Cancer

Session Information

• Onconephrology: Kidney Outcomes during Cancer Treatment and Nephropathies
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Trevisani, MD, PhD

• Cei, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Cei, MD

• Cignoli, Daniele, IRCCS Ospedale San Raffaele, Milano, Italy

Daniele Cignoli

• Belladelli, Federico, IRCCS Ospedale San Raffaele, Milano, Italy

Federico Belladelli, MD

• Re, Chiara, IRCCS Ospedale San Raffaele, Milano, Italy

Chiara Re, MD

• Musso, Giacomo, IRCCS Ospedale San Raffaele, Milano, Italy

Giacomo Musso, MD

• Bettiga, Arianna, IRCCS Ospedale San Raffaele, Milano, Italy

Arianna Bettiga

• Rowe, Isaline, IRCCS Ospedale San Raffaele, Milano, Italy

Isaline Rowe, PhD

• Lucianò, Roberta, IRCCS Ospedale San Raffaele, Milano, Italy

Roberta Lucianò

• Rosiello, Giuseppe, IRCCS Ospedale San Raffaele, Milano, Italy

Giuseppe Rosiello, APN

• Canibus, Daniela, IRCCS Ospedale San Raffaele, Milano, Italy

Daniela Canibus

• Fiorio, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Fiorio

• Bertini, Roberto, IRCCS Ospedale San Raffaele, Milano, Italy

Roberto Bertini, MD

• Salonia, Andrea, IRCCS Ospedale San Raffaele, Milano, Italy

Andrea Salonia

• Montorsi, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Montorsi

• Capitanio, Umberto, IRCCS Ospedale San Raffaele, Milano, Italy

Umberto Capitanio, MD

Background

The role of onco-nephrologists in renal cancer patients (RCC) is crucial due to the risk of surgical AKI and CKD. Despite the benefits of partial nephrectomy (PN) in preserving renal function, arterial clamping during surgery could lead to AKI and CKD, especially in RCC patients with comorbidities like hypertension, diabetes, or vascular diseases. This study aims to investigate the impact of PN on RCC patients with microcirculation impairment (MI)

Methods

Data are from 186 patients with microcirculation impairment undergoing elective partial nephrectomy (PN) for cT1-2 cN0 cM0 RCC. Impairments included hypertension, diabetes, peripheral vasculopathy, or vascular nephropathy. Ischemia time was the duration of clamping the renal artery without refrigeration. Primary outcome was the effect of warm ischemia time (WIT) on renal function postoperatively, at 6 months, and long term. Secondary outcome was hemorrhagic risk, defined as estimated blood loss (EBL) or peri-operative transfusions. Multivariable regression analyses were used

Results

A total of 139 patients (75%) underwent PN with WIT and 47 (25%) without. The baseline median eGFR was 71 mL/min/1.73m² for the on-clamp population and 61.4 mL/min/1.73m² for the off-clamp population. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (Est:−0.23, [P<0.001]). Conversely, no association between WIT and eGFR was recorded at 6-month or long-term follow-up (all P>0.1). At multivariable analyses predicting hemorrhagic risk, clampless resection with no ischemia time and PN with short WIT was associated with an increased EBL (Est:−25.77, [P=0.03]) and peri-operative transfusion rate (Est:−0.017, [P=0.04])

Conclusion

Patients and clinicians should know that performing partial nephrectomy (PN) with limited or zero warm ischemia time (WIT) in patients with microcirculation impairment does not improve long-term renal function and increases bleeding and transfusion risk. Our findings support hilum clamping even in these patients