Long-term renal function in patients with chronic kidney disease following radical cystectomy and orthotopic neobladder
© 2022 The Authors BJU International © 2022 BJU International..
OBJECTIVE: To evaluate long-term renal function in patients with chronic kidney disease (CKD) Stage IIIa who underwent radical cystectomy and orthotopic neobladder (RC/ONB) compared to matched controls.
PATIENTS AND METHODS: Using our Institutional Review Board-approved institutional database, patients with a glomerular filtration rate (GFR) of 45-59.9 mL/min/1.73 m2 who underwent RC/ONB were identified. A control group of patients with a GFR of ≥60 mL/min/1.73 m2 was selected. Groups were matched based on age, baseline hypertension/diabetes mellitus, perioperative chemotherapy, and preoperative hydronephrosis. A decrease in GFR of >10 mL/min/1.73 m2 during the follow-up was considered significant. A multivariate Cox regression analysis was performed to identify predictors of GFR decline in each group.
RESULTS: Of 1237 patients who underwent RC/ONB, 508 patients were included (254 per group). The mean preoperative GFR was 53.3 mL/min/1.73 m2 in the study group and 78.8 mL/min/1.73 m2 in controls. The median follow-up was 3.7 years. During follow-up, GFR stayed at or above baseline in 51% of the study patients compared to 46% of the controls (P = 0.5). The mean time to a significant GFR decline in the study patients was significantly longer compared to the controls (5.6 vs 2 years, respectively; P < 0.001). In multivariate analysis, neoadjuvant chemotherapy was found to be the strongest predictor of a significant GFR decline as well as GFR decline below baseline (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.4-3.29, P = 0.004; and HR 2.15, 95% CI 1.4-3.29, P < 0.001, respectively).
CONCLUSION: Patients with CKD Stage IIIa who undergo ONB appear to have comparable long-term renal function to those with a GFR of ≥60 mL/min/1.73 m2 . An ONB reconstruction is a safe option for patients with CKD Stage IIIa desiring a continent diversion.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:130 |
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| Enthalten in: |
BJU international - 130(2022), 2 vom: 07. Aug., Seite 200-207 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ahmadi, Hamed [VerfasserIn] |
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| Links: |
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| Themen: |
#BladderCancer |
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| Anmerkungen: |
Date Completed 19.07.2022 Date Revised 19.07.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/bju.15685 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM335787576 |
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| 100 | 1 | |a Ahmadi, Hamed |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-term renal function in patients with chronic kidney disease following radical cystectomy and orthotopic neobladder |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 19.07.2022 | ||
| 500 | |a Date Revised 19.07.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors BJU International © 2022 BJU International. | ||
| 520 | |a OBJECTIVE: To evaluate long-term renal function in patients with chronic kidney disease (CKD) Stage IIIa who underwent radical cystectomy and orthotopic neobladder (RC/ONB) compared to matched controls | ||
| 520 | |a PATIENTS AND METHODS: Using our Institutional Review Board-approved institutional database, patients with a glomerular filtration rate (GFR) of 45-59.9 mL/min/1.73 m2 who underwent RC/ONB were identified. A control group of patients with a GFR of ≥60 mL/min/1.73 m2 was selected. Groups were matched based on age, baseline hypertension/diabetes mellitus, perioperative chemotherapy, and preoperative hydronephrosis. A decrease in GFR of >10 mL/min/1.73 m2 during the follow-up was considered significant. A multivariate Cox regression analysis was performed to identify predictors of GFR decline in each group | ||
| 520 | |a RESULTS: Of 1237 patients who underwent RC/ONB, 508 patients were included (254 per group). The mean preoperative GFR was 53.3 mL/min/1.73 m2 in the study group and 78.8 mL/min/1.73 m2 in controls. The median follow-up was 3.7 years. During follow-up, GFR stayed at or above baseline in 51% of the study patients compared to 46% of the controls (P = 0.5). The mean time to a significant GFR decline in the study patients was significantly longer compared to the controls (5.6 vs 2 years, respectively; P < 0.001). In multivariate analysis, neoadjuvant chemotherapy was found to be the strongest predictor of a significant GFR decline as well as GFR decline below baseline (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.4-3.29, P = 0.004; and HR 2.15, 95% CI 1.4-3.29, P < 0.001, respectively) | ||
| 520 | |a CONCLUSION: Patients with CKD Stage IIIa who undergo ONB appear to have comparable long-term renal function to those with a GFR of ≥60 mL/min/1.73 m2 . An ONB reconstruction is a safe option for patients with CKD Stage IIIa desiring a continent diversion | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a #BladderCancer | |
| 650 | 4 | |a #blcsm | |
| 650 | 4 | |a #uroonc | |
| 650 | 4 | |a bladder cancer | |
| 650 | 4 | |a chronic kidney disease | |
| 650 | 4 | |a neobladder | |
| 650 | 4 | |a radical cystectomy | |
| 650 | 4 | |a renal function | |
| 700 | 1 | |a Reddy, Sharath |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Charles |e verfasserin |4 aut | |
| 700 | 1 | |a Douglawi, Antoin |e verfasserin |4 aut | |
| 700 | 1 | |a Ladi-Seyedian, Sanam |e verfasserin |4 aut | |
| 700 | 1 | |a Roberts, Sidney |e verfasserin |4 aut | |
| 700 | 1 | |a Ghoreifi, Alireza |e verfasserin |4 aut | |
| 700 | 1 | |a Ghodoussipour, Saum |e verfasserin |4 aut | |
| 700 | 1 | |a Bhanvadia, Sumeet K |e verfasserin |4 aut | |
| 700 | 1 | |a Djaladat, Hooman |e verfasserin |4 aut | |
| 700 | 1 | |a Schuckman, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Daneshmand, Siamak |e verfasserin |4 aut | |
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