Do Patients with Stage III-V Chronic Kidney Disease Benefit From Ischemia Sparing Techniques During Partial Nephrectomy?

OBJECTIVE: To analyze whether selective arterial clamping (SAC) and Off-Clamp (OC) techniques during robotic partial nephrectomy (RPN) are associated with a renal functional benefit in patients with stage III-V CKD.

METHODS: The change in eGFR over time was compared between patients with baseline CKD 3-5 that underwent RPN with main arterial clamping (MAC) (n=375, 81.2%), SAC (n=48, 10.4%) or OC (n=39, 8.4%) using a multivariable linear mixed effects model. All follow-up eGFR including baseline and follow-up between 3-24 months were included in the model for analysis. Median follow-up was 12.0 months (IQR 6.7-16.5; Range 3.0-24.0 Months). Perioperative outcomes were also compared with multivariable linear, logistic and Poisson regression models.

RESULTS: In the multivariable linear mixed effects model adjusting for characteristics including tumor size and the R.E.N.A.L. Nephrometry score, the change in eGFR over time was not significantly different between SAC and MAC RPN (β=-1.20; 95% CI=-5.45, 3.06; p=.582) and OC and MAC RPN (β=-1.57; 95% CI=-5.21, 2.08; p=.400). Only 20 (15 MAC, 2 SAC, 3 OC) patients overall experienced progression of their CKD stage at last follow-up. Mean ischemia time was 17 minutes for MAC and 15 minutes for SAC. There was no benefit to SAC or OC in terms of blood loss, perioperative complications, length of stay or surgical margins CONCLUSION: Selective clamping and off-clamp techniques during RPN were not associated with benefit in preservation of eGFR in patients with baseline CKD.