In:
World Journal of Urology, Springer Science and Business Media LLC, Vol. 41, No. 5 ( 2023-04-21), p. 1337-1344
Abstract:
To evaluate the relationship between warm ischemia time (WIT) duration and renal function after robot-assisted partial nephrectomy (RAPN). Methods The CLOCK trial is a phase 3 randomized controlled trial comparing on- vs off-clamp RAPN. All patients underwent pre- and postoperative renal scintigraphy. Six-month absolute variation of eGFR (AV-GFR), rate of relative variation in eGFR over 25% (RV-GFR 〉 25), absolute variation of split renal function (SRF) at scintigraphy (AV-SRF). The relationships WIT/outcomes were assessed by correlation graphs and then modeled by uni- and multivariable regression. Results 324 patients were included (206 on-clamp, 118 off-clamp RAPN). Correlation graphs showed a threshold on WIT equal to 10 min. The differences in outcome measures between cases with WIT 〈 vs ≥ 10 min were: AV-GFR − 3.7 vs − 7.5 ml/min ( p 〈 0.001); AV-SRF − 1% vs − 3.6% ( p 〈 0.001); RV-GFR 〉 25 9.3% vs 17.8% ( p = 0.008). Multivariable models found that AV-GFR was related to WIT ≥ 10 min (regression coefficient [RC] − 0.52, p = 0.019), age (RC − 0.35, p = 0.001) and baseline eGFR (RC − 0.30, p 〈 0.001); RV-GFR 〉 25 to WIT ≥ 10 min (odds ratio [OR] 1.11, p = 0.007) and acute kidney injury defined as 〉 50% increase in serum creatinine (OR 19.7, p = 0.009); AV-SRF to WIT ≥ 10 min (RC − 0.30, p = 0.018), baseline SRF (RC − 0.76, p 〈 0.001) and RENAL score (RC − 0.60. p = 0.028). The main limitation was that the CLOCK trial was designed on a different endpoint and therefore the present analysis could be underpowered. Conclusions Up to 10 min WIT had no consequences on functional outcomes. Above the 10-min threshold, a statistically significant, but clinically negligible impact was found.
Type of Medium:
Online Resource
ISSN:
1433-8726
DOI:
10.1007/s00345-023-04366-3
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2023
detail.hit.zdb_id:
1463303-6
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