Long‐term renal function in patients with chronic kidney disease following radical cystectomy and orthotopic neobladder
Hamed Ahmadi, Sharath S. Reddy, Charles Nguyen, Antoin Douglawi, Seyedeh‐Sanam Ladi‐Seyedian, Sidney Roberts, Alireza Ghoreifi, Saum Ghodoussipour, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand
Abstract
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 m 2 who underwent RC/ONB were identified. A control group of patients with a GFR of ≥60 mL/min/1.73 m 2 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 m 2 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 m 2 in the study group and 78.8 mL/min/1.73 m 2 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 m 2 . An ONB reconstruction is a safe option for patients with CKD Stage IIIa desiring a continent diversion.