Presentation Authors: Umberto Anceschi*, Rome, Italy, Riccardo Bertolo, Cleveland, OH, Aldo Brassetti, Gabriele Tuderti, Rome, Italy, Umberto Capitanio, Milan, Italy, Lance J Hampton, Virginia, VA, Maria Consiglia Ferriero, Rome, Italy, Alessandro Larcher, Milan, Italy, Alessandro Veccia, Brescia, Italy, Salvatore Guaglianone, Rome, Italy, Garisto Juan, Cleveland, OH, Alexander Mottrie, Aalts, Italy, Alessandro Antonelli, Brescia, Italy, Andrea Minervini, Florence, Italy, Paolo Dell'Oglio, Aalst, Belgium, Monish Aron, Los Angeles, CA, Daniel Eun, Temple, CA, Ithaar Derweesh, San Diego, CA, Francesco Porpiglia, Orbassano, Italy, Francesco Montorsi, Milan, Italy, Jihad Koauk, Cleveland, OH, Riccardo Autorino, Virginia, VA, Michele Gallucci, Giuseppe Simone, Rome, Italy
Introduction: There is paucity of data in literature describing the progression to chronic kidney disease (CKD) after robotic partial nephrectomy (RAPN) in the elective setting. The aim of this study is to evaluate the progression to chronic kidney disease stage 3a (CKD-3a) stage 3b (CKD-3b) stage 4-5 (CKD-4,5) and to identify predictors of CKD progression after RAPN for cT1 renal masses.
Methods: From September 2013 to October 2018, we analyzed 1336 pooled patients who underwent robotic elective RAPN for cT1 renal masses at five different high-volume institutions. Probabilities of developing newly onset 3a, 3b and 4-5 CKD stages were computed at 3,6,12,24,36,48 months after surgery; univariable and multivariable Cox regression analyses were performed to identify predictors of newly onset 3a, 3b, 4-5 CKD development. For all tests, statistical threshold was set at < 0.05.
Results: At a median follow-up of 24 months (IQR 8-41), probabilities of developing newly onset 3a, 3b and 4-5 CKD stages were 16.5%, 7.5% and 2.8%, respectively. Univariable and multivariable models were summarized in Table 1,2,3. On Cox multivariable analyses, age (p=.004), baseline eGFR (p=.001), ASA score (p=.003) and ischemia time (p=.001) were independent predictors of developing 3a-CKD stage; age (p=.007), baseline eGFR (p=.001), ischemia time (p=.001) and tumor size (0.002) of developing 3b-CKD stage, while baseline eGFR (p=.001), and ischemia time (p=0.016) were the only independent predictors of developing 4-5 CKD stages (Table 1).
Conclusions: Age, baseline eGFR and ASA score are significant drivers of the risks of renal function worsening after RAPN for cT1 renal tumors. Ischemia time remain a crucial, and surgically modifiable variable with independent role in determining postoperative development of clinically significant renal function deterioration.