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Bigot P, Bernhard JC, Khene ZE, Dariane C, Lebdai S, Doumerc N, Nouhaud FX, Ouzaid I, Saulnier P, Méjean A, Roupret M, Bensalah K. Nephrectomy for kidney tumour increases the risk of de novo arterial hypertension. BJU Int 2023; 132:575-580. [PMID: 37433580 DOI: 10.1111/bju.16124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To evaluate prospectively the effects of surgical excision of renal tumours on blood pressure (BP). PATIENTS AND METHODS In a multicentre prospective study, we evaluated 200 patients who underwent nephrectomy for renal tumour between 2018 and 2020 at seven departments of the French Network for Kidney Cancer, the UroCCR. All patients had localized cancer without pre-existing hypertension (HTN). Blood pressure was measured the week before nephrectomy, and at 1 month and 6 months after nephrectomy, according to the recommendations for home BP monitoring. Plasma renin was measured 1 week before surgery and 6 months after surgery. The primary endpoint was the occurrence of de novo HTN. The secondary endpoint was clinically significant increase in BP at 6 months, defined by an increase in systolic and/or diastolic ambulatory BP ≥10 mmHg or requirement for medical antihypertensive treatment. RESULTS Blood pressure and renin measurements were available for 182 (91%) and 136 patients (68%), respectively. We excluded from the analysis 18 patients who had undeclared HTN detected on preoperative measurements. At 6 months, 31 patients (19.2%) had de novo HTN and 43 patients (26.3%) had a significant increase in their BP. Type of surgery was not associated with an increased risk of HTN (21.7% partial nephrectomy [PN] vs 15.7% radical nephrectomy [RN]; P = 0.59). There was no difference between plasmatic renin levels before and after surgery (18.5 vs 16; P = 0.46). In multivariable analysis, age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12; P = 0.03) and body mass index (OR 1.14, 95% CI 1.03-1.26; P = 0.01) were the only predictors of de novo HTN. CONCLUSION Surgical treatment of renal tumours is associated with significant changes in BP, with de novo HTN occurring in almost 20% of the patients. These changes are not impacted by the type of surgery (PN vs RN). Patients who are scheduled to undergo kidney cancer surgery should be informed of these findings and have their BP closely monitored after the operation.
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Affiliation(s)
- Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
| | | | | | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Souhil Lebdai
- Department of Urology, Angers University Hospital, Angers, France
| | | | | | - Idir Ouzaid
- Department of Urology, Angers University Hospital, Paris, France
| | - Patrick Saulnier
- Department of Biostatistics, Angers University Hospital, Angers, France
| | - Arnaud Méjean
- Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
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Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, Klatte T, García-Chairez LR, González-Colmenero AD, Pallares-Méndez R, Cervantes-Miranda DE, Plata-Huerta HH, Rodriguez-Gutierrez R, Gutiérrez-González A. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis. Urol Oncol 2023; 41:113-124. [PMID: 36642639 DOI: 10.1016/j.urolonc.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/17/2022] [Accepted: 11/27/2022] [Indexed: 01/16/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.
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Affiliation(s)
- Mario Ochoa-Arvizo
- Edinburgh Medical School: Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Urology, IRCSS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Mariano García-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karla M Santos-Santillana
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Tobias Klatte
- Department of Urology, Charite-Universitaetmedizin, Berlin, Germany
| | - Luis R García-Chairez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro D González-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rigoberto Pallares-Méndez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniel E Cervantes-Miranda
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hiram H Plata-Huerta
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene- Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Gutiérrez-González
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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Wang X, Zhao X, Ji C, Liu G, Li X, Guo H. Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study. Int Urol Nephrol 2023; 55:29-36. [PMID: 36309925 PMCID: PMC9807541 DOI: 10.1007/s11255-022-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate whether extensive renal artery isolation during robotic-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC) affects blood pressure (BP) of patients with poorly controlled hypertension. METHODS We included 60 patients diagnosed with poorly controlled hypertension who underwent RAPN by an experienced surgeon. The renal artery of the treated kidney was sufficiently isolated. Systolic BP (SBP), diastolic BP (DBP) and antihypertensive medication information were obtained at baseline and 3- and 6-month follow-up after surgery. Primary endpoints were changes in BP, and medications. Predictors of SBP reduction at 3 months were assessed by multivariable logistic regression. RESULTS All 60 RAPN procedures were successful, with no major intra- or postoperative complications. Mean SBP and DBP decreased significantly at 3 months after surgery (SBP, -7.8 ± 6.3 mmHg, P < 0.001; DBP, -4.2 ± 6.4 mmHg, P = 0.01). SBP and DBP did not differ between 3- and 6-month follow-up. The mean number of BP medications prescribed was lower at 3 months than baseline (1.7 ± 1.0 vs 2.1 ± 1.0, P = 0.016). The only significant predictor of SBP reduction at 3 months was baseline SBP. CONCLUSIONS Renal denervation with extensive renal artery isolation during RAPN may improve BP control among patients with poorly controlled hypertension in short term.
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Affiliation(s)
- Xin Wang
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
| | - Xiaozhi Zhao
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
| | - ChangWei Ji
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
| | - Guangxiang Liu
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
| | - Xiaogong Li
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
| | - Hongqian Guo
- grid.41156.370000 0001 2314 964XDepartment of Urology, Drum Tower Hospital, Institute of Urology, Medical School of Nanjing University, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008 Jiangsu People’s Republic of China
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Gupta N, Ganesan V, Gao TM, Zabell J, Campbell SC, Haber GP. The effect of partial nephrectomy on blood pressure in patients with solitary kidney. World J Urol 2020; 39:1577-1582. [PMID: 32728886 DOI: 10.1007/s00345-020-03354-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
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.
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Affiliation(s)
- Nikhil Gupta
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA
| | - Vishnu Ganesan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tian-Min Gao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Zabell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA
| | - Georges-Pascal Haber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA.
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Incidence and Risk Factors of Hypertension Following Partial Nephrectomy in Patients With Renal Tumors: A Cross-sectional Study of Postoperative Home Blood Pressure and Antihypertensive Medications. Clin Genitourin Cancer 2020; 18:e619-e628. [PMID: 32144048 DOI: 10.1016/j.clgc.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/01/2020] [Accepted: 02/02/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the incidence and risk factors for nephrectomy-related hypertension (NR-HT) in patients with renal tumors who underwent partial nephrectomy (PN) or radical nephrectomy (RN). PATIENTS AND METHODS A retrospective cross-sectional follow-up survey of postoperative home blood pressure (BP) and defined daily dose (DDD) of antihypertensive medications was conducted in patients with renal tumors who underwent PN (210 patients) or RN (120 patients), and they were compared. We evaluated the incidence and risk factors for NR-HT, defined as the addition of antihypertensive medications in doses of 1 DDD or more after surgery, or postoperative BP of 140/90 mmHg with an increase of 20 mmHg from preoperative BP with no reduction in dose of antihypertensive medications. RESULTS Both systolic (mean, 124 vs. 129 mmHg; P < .001) and diastolic BP (mean, 74 vs. 79 mmHg; P < .001) significantly increased after PN compared with RN. Systolic (P < .001) and diastolic (P = .003) BP increased significantly more after PN than after RN, and NR-HT was more frequent after PN than after RN (16% vs. 5%; P = .002). PN (odds ratio [OR], 2.93; P = .022) and higher postoperative peak C-reactive protein (OR, 2.34; P = .017) were independently associated with NR-HT. When limited to only the patients who underwent PN, acute kidney injury (OR, 2.65; P = .036) and higher postoperative peak C-reactive protein (OR, 2.54; P = .016) were independent risk factors for NR-HT. CONCLUSION PN may cause postoperative progression of hypertension possibly through renal parenchymal damage.
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