Publication: Impact of Comorbidities on Functional Recovery from Partial Nephrectomy
Issued Date
2018-06-01
Resource Type
ISSN
15273792
00225347
00225347
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2-s2.0-85045890902
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Urology. Vol.199, No.6 (2018), 1433-1439
Suggested Citation
Sudhir Isharwal, Wenda Ye, Alice Wang, Joseph Abraham, Joseph Zabell, Wen Dong, Jitao Wu, Chalairat Suk-Ouichai, Elvis R. Caraballo, Tianming Gao, Steven C. Campbell Impact of Comorbidities on Functional Recovery from Partial Nephrectomy. Journal of Urology. Vol.199, No.6 (2018), 1433-1439. doi:10.1016/j.juro.2017.12.004 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46645
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Title
Impact of Comorbidities on Functional Recovery from Partial Nephrectomy
Abstract
© 2018 American Urological Association Education and Research, Inc. Purpose: Parenchymal mass preservation, and ischemia type and/or duration can influence functional recovery after partial nephrectomy. Some groups have hypothesized that relevant comorbidities may also impact nephron stability and functional recovery but this has not been adequately investigated. Materials and Methods: At our center 405 patients treated with partial nephrectomy from 2007 to 2015 had the necessary data to determine the function and parenchymal mass preserved in the ipsilateral kidney. Comorbidities potentially associated with renal functional status were reviewed, including various degrees of hypertension, diabetes, cardiovascular disease, obesity, smoking status and related medications. Multivariable linear regression was done to assess factors associated with functional recovery, defined as the percent of preserved ipsilateral glomerular filtration rate. Results: Median tumor size was 3.5 cm and the median R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touching main renal artery or vein) score was 8. Warm and cold ischemia were done in 264 (65%) and 141 patients for a median duration of 21 and 27 minutes, respectively. The median preserved ipsilateral glomerular filtration rate was 79%. Patient age, comorbidity index, hypertension and proteinuria were each associated with the preoperative glomerular filtration rate (all p <0.01). On univariable and multivariable analyses the preserved parenchymal mass, and ischemia type and duration were significantly associated with functional recovery (all p <0.001). On univariable analysis of comorbidities only hypertension was significantly associated with functional recovery. However, on multivariable analysis none of the analyzed comorbidities were associated with functional recovery. Conclusions: Recovery of function after partial nephrectomy depends primarily on parenchymal mass preservation and ischemia characteristics. Comorbidities failed to be associated with functional outcomes. Comorbidities can impact function, leading to surgery, and may influence long-term functional stability. However, our data suggest that they do not influence short-term recovery after partial nephrectomy.