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Impact of warm ischemia on acute kidney injury after robotic partial nephrectomy stratified by baseline kidney function.

PURPOSE
We evaluated the differences in baseline chronic kidney disease status in correlations between warm ischemic time (WIT) and acute kidney injury (AKI) or acute/chronic renal function change after robot-assisted partial nephrectomy (RAPN).


METHODS
This study retrospectively recruited 1,290 patients from a multi-institutional RAPN database. The patients were grouped into four preoperative chronic kidney disease (CKD) categories: CKD Group 1 (CKDG1), CKD Group 2 (CKDG2), CKD Group 3a (CKDG3a), and CDK Group 3b (CDKG3b). The correlation between WIT and the probability of AKI was assessed according to the baseline CKD grade, together with changes in serum creatinine (sCr) at the postoperative maximum and chronic renal function.


RESULTS
AKI was not observed in the CKDG1 group. The probability of AKI at WTI=30 min was 5.6% for CKDG2, 8.5% for CKDG3a, and 11.6% for CKDG3b (all p<0.05). WIT was an independent predictor of AKI occurrence in the multivariate model for these three CKD groups. Significant weak correlations were observed between WIT and sCr change for all four groups, with R2 =0.22 for CKDG1, R2 =0.16 for CKDG2, R2 =0.03 for CKDG3a, and R2 =0.09 for ≥CKDG3b. For chronic renal function, correlations were significant in CKDG2, CKDG3a, and ≥CKDG3b, yet R2 was considered small in all cases (<0.1).


CONCLUSIONS
The association between extended WIT and the probability of AKI increased in patients with more severe baseline CKD. The correlation between WIT and renal function was significant, yet clinically modest.