Abstract
Purpose
In pre-clinical studies, acute erythropoietin (EPO) administration has been shown to mitigate the deleterious effects of ischemia/reperfusion injury. We reviewed our clinical experience with intraoperative EPO administration as a potential renoprotective agent during laparoscopic partial nephrectomy (LPN).
Methods
Patients who underwent LPN at our institution between August 2008 and March 2010 received 500 IU/kg EPO 30 min prior to hilar occlusion. Those who underwent LPN between August 2006 and July 2008 without receiving EPO were selected as controls. Demographic, clinical, perioperative, and estimated glomerular filtration rate (eGFR) data were compared for the cohorts preoperatively, and during short-term (<6 months) and long-term (≥6 months) follow-up.
Results
Short-term eGFR was evaluable for 39 EPO and 29 controls, while long-term eGFR was evaluable for 26 EPO and 27 controls. Baseline demographic and clinical features of the cohorts were similar. For EPO versus controls, median short and long-term follow-up was 19 days versus 22 days and 10.2 months versus 11.9 months, respectively. Mean preoperative, postoperative, and % change in eGFR were statistically similar for the cohorts during short- and long-term follow-up, without and with adjustment for baseline renal function (unadjusted P-values = 0.28, 0.095, and 0.38, respectively, short term, and 0.61, 0.50, and 0.69, respectively, long term).
Conclusions
In this retrospective study, a single dose of EPO prior to hilar occlusion during LPN had no added protective impact on postoperative eGFR in the short or long term. Prospective evaluation in patients with solitary kidneys may better elucidate its potential renoprotective role in this setting.
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References
Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406
Matin SF, Gill IS, Worley S, Novick AC (2002) Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm or less renal tumor with a normal contralateral kidney. J Urol 168:1356–1360
Snow DC, Bhayani SB (2008) Rapid communication: chronic renal insufficiency after laparoscopic partial nephrectomy and radical nephrectomy for pathologic t1a lesions. J Endourol 22:337–341
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305
Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS (2008) Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol 179:847–852
Thompson RH, Lane BR, Lohse CM et al (2010) Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol 58:331–336
Desai MM, Gill IS, Ramani AP, Spaliviero M, Rybicki L, Kaouk JH (2005) The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy. BJU Int 95:377–383
Bhayani SB, Rha KH, Pinto PA et al (2004) Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol 172:1264–1266
Forman CJ, Johnson DW, Nicol DL (2007) Erythropoietin administration protects against functional impairment and cell death after ischaemic renal injury in pigs. BJU Int 99:162–165
Spandou E, Tsouchnikas I, Karkavelas G et al (2006) Erythropoietin attenuates renal injury in experimental acute renal failure ischaemic/reperfusion model. Nephrol Dial Transplant 21:330–336
Vesey DA, Cheung C, Pat B, Endre Z, Gobe G, Johnson DW (2004) Erythropoietin protects against ischaemic acute renal injury. Nephrol Dial Transplant 19:348–355
Sharples EJ, Patel N, Brown P et al (2004) Erythropoietin protects the kidney against the injury and dysfunction caused by ischemia-reperfusion. J Am Soc Nephrol 15:2115–2124
Imamura R, Moriyama T, Isaka Y et al (2007) Erythropoietin protects the kidneys against ischemia reperfusion injury by activating hypoxia inducible factor-1 alpha. Transplantation 83:1371–1379
Phillips CK, Hruby GW, Mirabile G et al (2009) Erythropoietin-induced optimization of renal function after warm ischemia. J Endourol 23:359–365
Prass K, Scharff A, Ruscher K et al (2003) Hypoxia-induced stroke tolerance in the mouse is mediated by erythropoietin. Stroke 34:1981–1986
Becker F, Van Poppel H, Hakenberg OW et al (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56:625–634
Spinowitz B, Germain M, Benz R et al (2008) A randomized study of extended dosing regimens for initiation of epoetin alfa treatment for anemia of chronic kidney disease. Clin J Am Soc Nephrol 3:1015–1021
Dicato M, Plawny L (2010) Erythropoietin in cancer patients: pros and cons. Curr Opin Oncol 22:307–311
Tanaka A, Suemaru K, Araki H (2007) A new approach for evaluating renal function and its practical application. J Pharmacol Sci 105:1–5
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Olweny, E.O., Mir, S.A., Park, S.K. et al. Intra-operative erythropoietin during laparoscopic partial nephrectomy is not renoprotective. World J Urol 30, 519–524 (2012). https://doi.org/10.1007/s00345-011-0760-6
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DOI: https://doi.org/10.1007/s00345-011-0760-6