Long term kidney outcomes After Radical Cystectomy: Incidence, Predictors, and Implications for Long-Term Surveillance

 

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https://storage.unitedwebnetwork.com/files/1099/4d8a844e7fe6a0123796b63ff244a657.pdf
Long term kidney outcomes After Radical Cystectomy: Incidence, Predictors, and Implications for Long-Term Surveillance

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Rajeevalochana
Parthasarathy
Rajeevalochana Parthasarathy jeevssri@gmail.com Medway Hospitals Nephrology Chennai India *
Aditi Deewan aditi04.diwan@gmail.com Cancer Institute Adyar, WIA Surgical oncology Chennai India -
Sanjeev Nair docsvn@gmail.com MIOT Hospitals Nephrology Chennai India -
Shalini Shree Krishnamurthy docshal87@gmail.com Cancer Institute Adyar WIA Surgical oncology Chennai India -
Venkataraman Radhakrishnan venkymd@gmail.com Cancer Institute Adyar WIA Medical Oncology Chennai India -
Veenaa Manjari veenaa3218@gmail.com Medway Hospitals Nephrology Chennai India -
Syeda Hurmath drsyedahurmath@gmail.com Trustwell Hospitals Nephrology Bengaluru India -
Kenar Jhaveri kjhaveri@northwell.edu Northwell Health, Zucker School of Medicine Nephrology New York United States -
Madhusri Babu madhusribabu2903@gmail.com Medway Hospitals Nephrology Chennai India -
Subashri Mohanasundaram subashrimohan@gmail.com Prashant Hospitals Nephrology Chennai India -
Sukanya Govindan sukanyagovindan@gmail.com Mehta Hospitals Pediatric nephrology Chennai India -
Anand Raja dr_anand@yahoo.com Cancer Institute, Adyar, WIA Surgical Oncology Chennai India -
 
 
 

Decline in renal function after Radical Cystectomy (RC) for bladder cancer, besides cancer recurrence and progression, is an important prognostic factor for survival. Although several studies worldwide have investigated the decline in renal function after RC, no large-scale analyses have been made in India. This study aimed to evaluate the long-term renal function following RC for bladder cancer and identify the risk factors associated with postoperative decline in renal function.

This retrospective single-centre study included patients who underwent RC from January 2014 to December 2018. Renal function was evaluated by estimated glomerular filtration rate (eGFR) by CKD-EPI 2021 formula using pre and postoperative serial creatinine measurements. Cox Proportional Hazards models were used to describe the loss of renal function and its association with clinicopathological variables, as well as its effect on mortality.

After exclusions, 72 patients were eligible for analyses. Median follow-up time was 30.5 months. The proportion of patients with chronic kidney disease (CKD) stage G3 or worse increased from 9.45% before RC to 35.8% at 5 years after surgery, with 4.05% patients becoming dialysis dependent. Loss of renal function was associated with lower median survival (46 months vs 56 months), although not statistically significant. In multivariate analysis, lower preoperative eGFR, preoperative hydroureteronephrosis, pre-existing hypertension, postoperative pyelonephritis and recurrent urinary tract infections were all independently associated with renal function decline

The long-term renal function decreases considerably for a large number of RC patients. Recognizing preoperative risk factors could identify patients who benefit from enhanced renal surveillance or early intervention for modifiable factors to minimise renal insufficiency following RC

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