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Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy

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Abstract

We aimed to evaluate the renoprotective effects of remote ischemic preconditioning (RIPC) in patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN). Data from 59 patients with solitary renal tumors who underwent RAPN with RIPC comprising three cycles of 5-min inflation to 200 mmHg of a blood pressure cuff applied to one lower limb followed by 5-min reperfusion by cuff deflation, from 2018 to 2020 were analyzed. Patients who underwent RAPN for solitary renal tumors without RIPC between 2018 and 2020 were selected as controls. The postoperative estimated glomerular filtration rate (eGFR) at the nadir during hospitalization and the percentage change from baseline were compared using propensity score matching analysis. We performed a sensitivity analysis with imputations for missing postoperative renal function data weighted by the inverse probability of the data being observed. Of the 59 patients with RIPC and 482 patients without RIPC, 53 each were matched based on propensity scores. No significant differences in the postoperative eGFR in mL/min/1.73 m2 at nadir (mean difference 3.8; 95% confidence interval [CI] – 2.8 to 10.4) and its percentage change from baseline (mean difference 4.7; 95% CI – 1.6 to 11.1) were observed between the two groups. Sensitivity analysis also indicated no significant differences. No complications were associated with the RIPC. In conclusion, we found no significant evidence of the protective effect of RIPC against renal dysfunction after RAPN. Further research is required to determine whether specific patient subgroups benefit from RIPC.

Trial registration number: UMIN000030305 (December 8, 2017).

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Data availability

The datasets used and/or analyzed in the current study can be made available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Ms. Nobuko Hata and Ms. Miyuki Sato for administrative and technical support. We also thank Prof. Kali Tal and Editage (www.editage.jp) for the English language editing.

Funding

This study was supported by an unrestricted research grant from the Institute for Health Outcomes & Process Evaluation Research (iHope International) and PeDAL (Patient Driven Academic League). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Kenji Omae

  2. Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan

    Kenji Omae

  3. Department of Urology, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan

    Tsunenori Kondo, Daisuke Toki & Toshihide Horiuchi

  4. Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Shingo Fukuma & Tatsuyoshi Ikenoue

  5. Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan

    Tatsuyoshi Ikenoue

  6. Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan

    Hidekazu Tachibana, Ryo Ishiyama, Maki Yoshino, Yudai Ishiyama & Toshio Takagi

  7. Department of Urology, Saiseikai Kazo Hospital, Kazo, Japan

    Hidekazu Tachibana

  8. Department of Urology, Toda Chuo General Hospital, Toda, Japan

    Yudai Ishiyama

  9. Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan

    Shunichi Fukuhara

  10. Department of Health Policy Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Shunichi Fukuhara

  11. Robotic Surgery/Organ Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan

    Kazunari Tanabe

Authors
  1. Kenji Omae
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  2. Tsunenori Kondo
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  3. Shingo Fukuma
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  4. Tatsuyoshi Ikenoue
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  5. Daisuke Toki
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  7. Toshihide Horiuchi
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  8. Ryo Ishiyama
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  9. Maki Yoshino
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  11. Shunichi Fukuhara
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  12. Kazunari Tanabe
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  13. Toshio Takagi
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Contributions

KO: Conceptualization, formal analysis, funding acquisition, methodology, software, visualization, writing and original draft. TK: Conceptualization, data curation, project administration, writing, review, and editing. SF: Conceptualization, methodology, validation, writing, review, and editing. TI: Conceptualization; methodology; validation; writing, review and editing. DT: Data curation, investigation, resources, writing, review, and editing. HT: Data curation, investigation, resources, writing, review and editing. TH: Data curation, investigation, resources, writing, review and editing. RI: Data curation, investigation, resources, writing, review, and editing. MY: Data curation, investigation, resources, writing, review, and editing. YI: Data curation, investigation, resources, writing, reviewing, and editing. SF: Conceptualization, methodology, supervision, writing, review, and editing. KT: Data curation, investigation, resources, project administration, supervision, writing, review, and editing. TT: Data curation, investigation, resources, project administration, supervision, writing, review, and editing.

Corresponding author

Correspondence to Kenji Omae.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Review Board of Tokyo Women’s Medical University (approval number: 171102).

Consent to participate

Written informed consent was obtained from all patients who received the intervention.

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Omae, K., Kondo, T., Fukuma, S. et al. Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy. J Robotic Surg 17, 2081–2087 (2023). https://doi.org/10.1007/s11701-023-01616-9

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  • DOI: https://doi.org/10.1007/s11701-023-01616-9

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