Ischemic Preconditioning Reduces the Severity of Acute Kidney Injury After Partial Nephrectomy

The study cohort was randomly divided into two groups. One group received remote ischemic preconditioning one day before partial nephrectomy, while the other group underwent partial nephrectomy directly. The degree of acute renal injury on the operated side was compared between the two groups

• Ischemic preconditioning (Procedure): One day before the surgery, use a sphygmomanometer to apply pressure to the patient's upper limb to 200mmHg for 5 minutes, then reduce the pressure to 0mmHg for 5 minutes, repeating this process for a total of 3 cycles. On the second day, perform a routine partial nephrectomy
• NO ischemic preconditioning (Procedure): Routine partial nephrectomy

Primary outcomes

• AIRD spectrum score based on the patient's preoperative creatinine level and postoperative peak creatinine level [2 weeks after partial nephrectomy]: The AIRD spectrum score was defined as: (observed peak SCr - SCr ideal-peak)/(SCr worstcase-peak - SCr ideal-peak） The range of this indicator should be between 0 and 1, with 0 and 1 representing two extreme situations. 0 indicates that the kidney on the operated side is completely undamaged, while 1 indicates that the kidney on the operated side has completely lost its function.

Secondary outcomes

• Recovery from ischemia based on the changes in creatinine levels before and after the partial nephrectomy and volume retention rate after the partial nephrectomy [3 month after surgery]: Recovery from ischemia = (%GFR saved)/(%parenchymal mass preserved)

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

* Patients who are scheduled to undergo partial nephrectomy, with no specific surgical procedure limitation, including laparoscopic surgery, robot-assisted surgery, and open surgery
* Aged 18 to 80
* Possess good organ function status: sufficient organ function (based on the normal values of the clinical trial center)

  1. Blood routine test: WBC≥3.5×10\^9/L, absolute neutrophil count ≥1.5×10\^9/L, PLT≥75.0×10\^9/L, HGB≥80g/L;
  2. Liver function: Total bilirubin ≤1.5×upper limit of normal (ULN), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5×ULN;

Exclusion Criteria:

* The anesthesiologist assesses that the patient cannot tolerate general anesthesia surgery
* Individuals with severe cardiovascular and cerebrovascular diseases, uncontrolled hypertension, and diabetes
* Estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m²
* Horseshoe kidney
* Solitary kidney
* Pregnant women

• Fangjian Zhou, professor, Principal investigator, Sun Yat-sen University Cancer Center (SYSUCC)