The impact of intraoperative bleeding on the risk of chronic kidney disease after nephron-sparing surgery
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ORIGINAL ARTICLE
The impact of intraoperative bleeding on the risk of chronic kidney disease after nephron‑sparing surgery Giuseppe Rosiello1 · Alessandro Larcher1 · Giuseppe Fallara1 · Giuseppe Basile1 · Daniele Cignoli1 · Gianmarco Colandrea1 · Chiara Re1 · Francesco Trevisani1 · Pierre I. Karakiewicz2 · Andrea Salonia1 · Roberto Bertini1 · Alberto Briganti1 · Francesco Montorsi1 · Umberto Capitanio1 Received: 2 August 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The current literature regarding the effect of blood loss (eBL) after nephron-sparing surgery (NSS) on long-term renal function is scarce. We tested the effect of eBL on the risk of developing chronic kidney disease (CKD) after NSS. Methods Within an institutional prospectively maintained database, we identified 215 patients treated with NSS for cT1N0M0 renal mass at one European high-volume center. Multivariable logistic regression models tested the effect of eBL on the risk of developing CKD, after accounting for surgical complexity, individual clinical characteristics, and surgical experience. Multivariable linear regression models identified predictors of eBL. Results After a median follow-up of 36 months, 55 (25.6%) patients experienced CKD after surgery. At multivariable analyses, eBL independently predicted higher risk of CKD after NSS (odds ratio [OR]: 1.16; 95% confidence intervals [CI] 1.04–1.30; p 30 procedures) from 2005 to 2019. For the purpose of the analyses, only patients with preoperative estimated glomerular filtration rate (eGFR) ≥ 60 mL/min were included. Finally, patients with single kidney (n = 3) and missing follow-up (n = 7) were excluded from our analyses.
Outcomes and variables CKD was defined as persistence of eGFR 3 months, according to the Kidney Disease: Improving Global Outcome (K-DIGO) G-categories definition [10]. Functional outcomes and related eGFR measurements were assessed at 7-day, 1-, 3-, 6-month follow-up, and every 6 months from 12-month follow-up onward. eBL was recorded and reported on the final surgical report by the scrub nurse at the end of each surgery, based on the volume drained into aspiration systems and weight of wet gauzes, subtracting the weight of dry gauzes and volume of saline solution, according to different surgical approaches and throughout the study period [11]. AKI was defined according to the RIFLE criteria [12] and following a recent consensus definition [13], was calculated up to 7 days after surgery. For each individual patient, surgical experience (EXP) was defined as the total number of NSSs performed by each surgeon before the patient’s operation [14]. Finally, tumor complexity was defined using the total PADUA score [15] and was tested as continuous variable. Other variables included continuously coded age at surgery, body mass index, preoperative estimated glomerular filtration rate (eGFR), Charlson comorbidity index (CCI), clinical size, ischemia time, and year of diagnosis. Moreover, hypertension (present v
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