Presentation Authors: Jae-Seung Chung*, Busan, Korea, Republic of, Seok-Soo Byun, Sung Kyu Hong, Sang Eun Lee, Seongnam, Korea, Republic of, Chang Wook Jeong, Cheol Kwak, Hyeon Hoe Kim, Seoul, Korea, Republic of, Jinsoo Chung, Goyang, Korea, Republic of, Sung Hoo Hong, Seoul, Korea, Republic of, Yong June Kim, Cheongju, Korea, Republic of, Seok Ho Kang, Seoul, Korea, Republic of, Eu Chang Hwang, Jeonnam, Korea, Republic of, Tae Gyun Kwon, Daegu, Korea, Republic of
Introduction: The benefit of short warm ischemic time(WIT) in partial nephrectomy (PN) is still under debate. Especially, little is known about the effect of such ischemia on long-term renal function after PN in patients with chronic kidney disease(CKD). We evaluate longitudinal renal function after PN according to warm ischemic time(WIT) in patients with CKD stage III.
Methods: We studied 2857 patients who underwent PN for renal cell carcinoma between 2004 and 2017. A total of 277 patients who underwent PN with CKD stage III (estimated glomerular filtration rate[eGFR] of 30-60 ml/min/1.73 m2) were identified. Patients were divided into two subgroups (Group A: 0â‰¤WIT < 25 min, Group B: 25 minâ‰¤WIT). We used 1:1 propensity score matching to adjust for age, gender, tumor size, comorbidities (diabetes, hypertension) and baseline renal function (eGFR). We compared the serial renal function between the two groups. The probabilities of freedom from CKD stage IV (eGFR < 30 ml/min/1.73 m2) and Overall survival (OS) rate were evaluated using the Kaplan-Meier method.
Results: After propensity matching, 85 group A patients were matched with 85 group B patients. The median follow-up duration in the group A and B were 49 (IQR,13-83) and 42 (IQR,11-68) months, respectively. The median pre-eGFRs were 52.4 and 52.6 ml/min/1.73 m2 in each arm (Group A vs. Group B). There were no significant differences in renal function between the two groups, regardless of the entire postoperative period (all P>0.05, Figure A). The 5-year CKD IV-free survival rates after surgery were not significantly different between the two groups. (Figure B). The incidence of new onset CKD stage IV were 8.2% (group A) and 7.1% (group B). The probabilities of freedom from CKD IV after PN were 90.4% for group A versus 86.8% for group B (P=0.229). In Cox hazards models for CKD stage IV, group A was not significantly different compared with group B (hazard ratio [HR],0.527; 95% CI, 0.183-1.521; P=0.236). Furthermore, The 5-year OS rates were 90.3% for group A versus 96.2% for group B. (P=0.549, Figure C)
Conclusions: Our data suggest that short WIT has no beneficial effect on renal function and survival rate after PN in patients with pre-existing CKD stage III.