Santok Glen Denmer, Abdel Raheem Ali, Chang Ki Don, Kim Lawrence, Lum Trenton G, Alenzi Mohamed Jayed, Han Woong Kyu, Choi Young Deuk, Rha Koon Ho
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Urology, Tanta University Medical School, Tanta, Egypt.
Int J Urol. 2018 Jul;25(7):660-667. doi: 10.1111/iju.13589. Epub 2018 May 6.
To investigate the impact of postoperative time to nadir of estimated glomerular filtration rate on renal functional changes after robot-assisted partial nephrectomy.
From 2006 to 2015, 287 patients with renal mass who underwent robot-assisted partial nephrectomy in a referral center were analyzed. The cohort was evaluated based on their time to develop nadir: group 1 (no nadir), group 2 (<48 h) and group 3 (≥48 h). The outcome measures were to evaluate the renal function recovery between groups, risk factors for development of nadir ≥48 h, as well as predictors of chronic kidney disease upstaging.
The mean estimated glomerular filtration rate percentage change was the worst in group 3 compared with groups 1 and 2, with 13.8%, -0.67% and 8%, respectively (P < 0.001). Chronic kidney disease upstaging was more common in group 3 compared with the other groups (P < 0.001). Age, tumor size, PADUA score and warm ischemia time were predictors of developing ≥48 h estimated glomerular filtration rate nadir (odds ratio 1.04, P = 0.002; odds ratio 1.43, P < 0.001; odds ratio 1.24, P = 0.018; odds ratio 1.05, P < 0.001), respectively. The 5-year probability of freedom from chronic kidney disease upstaging was lower in group 3 (75.6%) compared with the other groups - 88.1% and 100% (P = 0.003). Time to nadir ≥48 h was a predictor of chronic kidney disease upstaging (odds ratio 3.02, P = 0.022).
A continuous decline in estimated glomerular filtration rate (≥48 h) after partial nephrectomy is associated with increased risk of poor functional recovery overtime. Age, tumor size, PADUA score and warm ischemia time are independent predictors of developing ≥48 h time to nadir of estimated glomerular filtration rate. This higher risk subgroup should be targeted for stricter follow up to allow early detection of future risk of renal functional decline.
探讨机器人辅助肾部分切除术后估算肾小球滤过率降至最低点的时间对肾功能变化的影响。
对2006年至2015年在一家转诊中心接受机器人辅助肾部分切除术的287例肾肿物患者进行分析。根据出现最低点的时间对该队列进行评估：第1组（未出现最低点）、第2组（<48小时）和第3组（≥48小时）。结局指标是评估各组之间的肾功能恢复情况、最低点≥48小时出现的危险因素以及慢性肾脏病分期升级的预测因素。
与第1组和第2组相比，第3组估算肾小球滤过率的平均百分比变化最差，分别为13.8%、-0.67%和8%（P<0.001）。与其他组相比，第3组慢性肾脏病分期升级更为常见（P<0.001）。年龄、肿瘤大小、PADUA评分和热缺血时间分别是估算肾小球滤过率最低点≥48小时出现的预测因素（比值比1.04，P=0.002；比值比1.43，P<0.001；比值比1.24，P=0.018；比值比1.05，P<0.001）。与其他组（88.1%和100%）相比，第3组慢性肾脏病分期升级的5年无病概率较低（75.6%）（P=0.003）。最低点≥48小时的时间是慢性肾脏病分期升级的预测因素（比值比3.02，P=0.022）。
肾部分切除术后估算肾小球滤过率持续下降（≥48小时）与长期功能恢复不良的风险增加相关。年龄、肿瘤大小、PADUA评分和热缺血时间是估算肾小球滤过率最低点≥48小时出现的独立预测因素。应针对这个高风险亚组进行更严格的随访，以便早期发现未来肾功能下降的风险。
