Limiting blood flow interruption during kidney surgery avoids chronic kidney disease

ROCHESTER, Minn. -- Interrupting the blood flow for more than 20 to 25 minutes during kidney cancer (http://www.mayoclinic.org/kidney-cancer/research.html) surgery leads to a greater risk for patients developing chronic kidney disease, a Mayo Clinic and Cleveland Clinic collaborative research team has found. The study was published today in the journal, European Urology.

For the retrospective study, researchers analyzed outcomes of 362 patients with only one kidney who underwent surgery for renal cortical tumors at Mayo Clinic and Cleveland Clinic between 1990 and 2008. Using a technique called warm ischemia, surgeons kept the patient's kidneys at body temperature during the partial nephrectomy. Ischemia involves cutting off the blood supply to the kidney with clamps in order to control bleeding and to keep blood from obscuring the surgeon's view of the kidney. It also allows for precise closure of the urine collecting system and the surgical opening. The median ischemia time was 21 minutes in the study and the median age of patients was 62 years.

Ischemia can cause tissue damage from a lack of oxygen and nutrients. Researchers found that each additional minute of warm ischemia is associated with a 5 to 6 percent increase in the odds of developing acute renal failure or reduced kidney functioning and is associated with a 6 percent increased risk of new onset Stage IV chronic kidney disease during long-term follow-up.

"This is the largest evaluation of warm ischemia time in patients with a single kidney who are undergoing a partial nephrectomy, combining the experiences of the Mayo Clinic and Cleveland Clinic, both leaders in the field of kidney cancer," says R. Houston Thompson, M.D., (http://www.mayoclinic.org/bio/13623818.html) Mayo Clinic urologist and the study's primary investigator. "These results suggest that every minute counts when the renal arteries and veins are clamped. When planning for the surgery, surgeons should make efforts to minimize ischemia time, especially in situations where a person only has one kidney."

"Historically, 30 minutes was considered the maximum safe duration of warm ischemia during partial nephrectomy, and other retrospective clinical studies have suggested that warm ischemia for 40 to 55 minutes is safe," says Dr. Thompson. "However, these studies included patients with two kidneys, which could mask the true effects of ischemia on renal function.

"Because each additional minute of warm ischemia invites the risk for chronic kidney problems, if longer ischemic times are unavoidable, techniques such as ice slush (cold ischemia) should be considered."

The researchers stress that the study's results do not have implications for patients treated with cold ischemia.

Collaborators include Brian Lane, M.D.; Amr Fergany, M.D. and Steven Campbell, M.D. with the Glickman Urological Institute, Cleveland Clinic Foundation; Christine Lohse, Bradley Leibovich, M.D., (http://www.mayoclinic.org/bio/12144681.html); Igor Frank, M.D., (http://www.mayoclinic.org/bio/12529231.html) and Michael Blute, M.D., all of Mayo Clinic; and Inderbir Gill, M.D., Keck School of Medicine, University of Southern California.

To request an appointment at Mayo Clinic, please call 480-422-1490 for the Arizona campus, 904-494-6484 for the Florida campus, or 507-216-4573 for the Minnesota campus.

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world's leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients' health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic's campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information.

VIDEO ALERT: A video interview with Dr. R. Houston Thompson describing the research is available on the News Blog (http://newsblog.mayoclinic.org/2010/06/11/limiting-blood-flow-interruption-during-kidney-surgery-helps-avoid-chronic-kidney-disease/).