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Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery
Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function an...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777389/ https://www.ncbi.nlm.nih.gov/pubmed/36547181 http://dx.doi.org/10.3390/curroncol29120767 |
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author | Buse, Stephan Mager, René Mazzone, Elio Mottrie, Alexandre Frees, Sebastian Haferkamp, Axel |
author_facet | Buse, Stephan Mager, René Mazzone, Elio Mottrie, Alexandre Frees, Sebastian Haferkamp, Axel |
author_sort | Buse, Stephan |
collection | PubMed |
description | Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted. |
format | Online Article Text |
id | pubmed-9777389 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-97773892022-12-23 Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery Buse, Stephan Mager, René Mazzone, Elio Mottrie, Alexandre Frees, Sebastian Haferkamp, Axel Curr Oncol Article Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted. MDPI 2022-12-10 /pmc/articles/PMC9777389/ /pubmed/36547181 http://dx.doi.org/10.3390/curroncol29120767 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Buse, Stephan Mager, René Mazzone, Elio Mottrie, Alexandre Frees, Sebastian Haferkamp, Axel Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title | Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title_full | Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title_fullStr | Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title_full_unstemmed | Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title_short | Impact of Blood Loss on Renal Function and Interaction with Ischemia Duration after Nephron-Sparing Surgery |
title_sort | impact of blood loss on renal function and interaction with ischemia duration after nephron-sparing surgery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777389/ https://www.ncbi.nlm.nih.gov/pubmed/36547181 http://dx.doi.org/10.3390/curroncol29120767 |
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