Nikhil Gupta1, Vishnu Ganesan2, Tian-Min Gao3, Joseph Zabell4, Steven C Campbell1, Georges-Pascal Haber5. 1. Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA. 2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Urology, University of Minnesota, Minneapolis, MN, USA. 5. Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA. haberg2@ccf.org.
Abstract
PURPOSE: To determine the effect of partial nephrectomy (PN) in the solitary kidney on systolic and diastolic blood pressures (SBP and DBP, respectively), and use of antihypertensive medications. METHODS: We performed a retrospective cohort study of solitary kidney patients who underwent PN for kidney cancer from 1999-2015. Primary outcomes evaluated were blood pressure (BP) and antihypertensive medication changes from baseline up to 5 years postoperatively. Using a multivariable mixed-effects model to account for repeated measurements, we evaluated the effect of PN on the outcome measurements while controlling for baseline patient, pathologic, and perioperative characteristics. RESULTS: 292 patients who underwent PN on solitary kidneys met inclusion criteria (median [range] age, 63 [24-84] years; 179 men [61%]). SBP decreased immediately postoperatively (- 1.7 mmHg [- 2.6, - 0.7], p < 0.001), and further decreased by 0.04 mmHg per year (p = 0.01) postoperatively, for a total change of - 1.9 [- 3.9, 0.2] mmHg at 5 years (p = 0.01). DBP decreased immediately postoperatively (- 2.2 mmHg [- 2.7, - 1.7], p < 0.001), and then rebounded by 0.37 mmHg per year (p = 0.003) postoperatively, for a total change of - 0.4 [- 1.5, 0.7] mmHg at 5 years (p = 0.003). Antihypertensive medication use increased at 5 years (0.35 more medications per patient, p < 0.001). CONCLUSIONS: Our results suggest a minimal change in BP after PN, although patients increased antihypertensive medication use. This data suggests damage to renal parenchyma or hilar nerves during PN did not significantly impact BP regulation in our cohort.
PURPOSE: To determine the effect of partial nephrectomy (PN) in the solitary kidney on systolic and diastolic blood pressures (SBP and DBP, respectively), and use of antihypertensive medications. METHODS: We performed a retrospective cohort study of solitary kidney patients who underwent PN for kidney cancer from 1999-2015. Primary outcomes evaluated were blood pressure (BP) and antihypertensive medication changes from baseline up to 5 years postoperatively. Using a multivariable mixed-effects model to account for repeated measurements, we evaluated the effect of PN on the outcome measurements while controlling for baseline patient, pathologic, and perioperative characteristics. RESULTS: 292 patients who underwent PN on solitary kidneys met inclusion criteria (median [range] age, 63 [24-84] years; 179 men [61%]). SBP decreased immediately postoperatively (- 1.7 mmHg [- 2.6, - 0.7], p < 0.001), and further decreased by 0.04 mmHg per year (p = 0.01) postoperatively, for a total change of - 1.9 [- 3.9, 0.2] mmHg at 5 years (p = 0.01). DBP decreased immediately postoperatively (- 2.2 mmHg [- 2.7, - 1.7], p < 0.001), and then rebounded by 0.37 mmHg per year (p = 0.003) postoperatively, for a total change of - 0.4 [- 1.5, 0.7] mmHg at 5 years (p = 0.003). Antihypertensive medication use increased at 5 years (0.35 more medications per patient, p < 0.001). CONCLUSIONS: Our results suggest a minimal change in BP after PN, although patients increased antihypertensive medication use. This data suggests damage to renal parenchyma or hilar nerves during PN did not significantly impact BP regulation in our cohort.
Authors: Pavel S Roshanov; Bram Rochwerg; Ameen Patel; Omid Salehian; Emmanuelle Duceppe; Emilie P Belley-Côté; Gordon H Guyatt; Daniel I Sessler; Yannick Le Manach; Flavia K Borges; Vikas Tandon; Andrew Worster; Alexandra Thompson; Mithin Koshy; Breagh Devereaux; Frederick A Spencer; Robert D Sanders; Erin N Sloan; Erin E Morley; James Paul; Karen E Raymer; Zubin Punthakee; P J Devereaux Journal: Anesthesiology Date: 2017-01 Impact factor: 7.892